The 1999 Guide to

Federal

Employees

Health Benefits Plans

for

Federal Retirees

and their

Survivors

United States Retirement and

Office of Insurance

Personnel Service RI 70-9

Management Revised November 1998
The U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits

(FEHB) Program, the largest employer-sponsored health insurance program in the world. We interpret the

health insurance laws and write regulations for the FEHB Program. We give advice and help to agencies and

retirement systems so they can process your enrollment changes and deduct your premium. We also contract

with and monitor your plan — and almost 300 other health plans — that pay claims or provide care to covered

members.

This is our commitment to you:

l Your choice of health benefits plans will compare favorably for value and selection with the private

sector.

l When you use the FEHB Guide and plan benefit brochures, you will find they are clear, factual and

give you the information you need.

l When you change plans or options, your new plan will issue your identification card within 15 days

after it gets your enrollment form from your agency or retirement system.

l Your fee-for-service plan should pay your claims within 20 work days; if more information is

needed, it should pay within 60 days.

l If you ask us to review a claim dispute with your plan, our decision will be fair and easy to

understand, and we’ll send it to you within 60 days. If you need to do more before we can review a

claim dispute, we will tell you within 14 work days what you still need to do.

l When you write to us about other matters, we will respond within 30 days after we get your letter. If

we need time to give you a complete response, we will let you know.

Our Commitment to Our Customers

Better Information

Better Choices

Better Health
Page

FEHB and You ....................................................1

Program Features ..................................................4

Patient Bill of Rights and Responsibilities ..................................5

Definitions and Explanations...........................................6

Your Links to Information

1999 FEHB Web Site ............................................8

Quality Indicators

Accreditation .................................................9

1998 Customer Satisfaction Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Medicare & You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Plan Report Cards

Nationwide Managed Fee-for-Service Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Plans Offering a Point of Service Product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Health Maintenance Organization Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Ü Things to Remember

l A number of plans withdrew from the FEHB Program.

Make sure your plan will be offered in 1999

l Be aware of 1999 benefit changes

l Check the 1999 premium

The information in the 1999 Guide to Federal Employees Health Benefits (FEHB) Plans gives you an

overview of the FEHB Program and its participating plans. Before making any final decisions about health

plans, be sure to check the plans’ brochure.

i

Table o f Contents
WARNING

The Federal Employees Health Benefits (FEHB) Program can help you meet your health care needs. Federal employees, retirees and their survivors enjoy the

widest selection of health plans in the country. You

can choose from among Managed Fee-for-Service

(FFS) plans, regardless of where you live, or Plans

offering a Point of Service (POS) Product and Health

Maintenance Organizations (HMO) if you live (or

sometimes if you work) within the area serviced by

the plan. (See page 6 for definitions.)

Some FFS plans are open to all enrollees, but others

require that you join the organization that sponsors

the plan. Some plans limit enrollment to certain

employee groups. Membership requirements and/or

limitations also apply to any POS product the FFS

plan may be offering.

You may voluntarily cancel your enrollment at any

time. However, once your cancellation takes effect,

you probably will not be able to enroll again as a

retiree. You will not be entitled to a 31-day extension

of coverage for conversion to a non-group (private)

policy and neither you nor your family members will

be entitled to temporarily continue coverage.

You will not be able to reenroll in FEHB except under

the following circumstances:

l You have been continuously covered as a

family member under another enrollment in

FEHB since the date of your cancellation,

and you lose the coverage because the enrollment ends or the enrollee changes from self

and family to self only; or

l You suspended your FEHB coverage to enroll

in a Medicare-sponsored health plan under

the Social Security Act or because you are

eligible under Medicaid or a similar Statesponsored program of medical assistance for

the needy.

Managed care is an important part of the FEHB Program. You will find managed care features in all the

plans described in this Guide. Common features of

managed care are pre-approval of hospital stays, the

use of primary care providers as “gatekeepers” to

coordinate your medical care, and networks of physicians and other providers.

You are fortunate to be able to choose from among

many different health plans competing for your business. Use this Guide to compare the costs, benefits,

and features of different plans. The plan brochures

tell you what services and supplies are covered and

the level of coverage. Look over the brochures carefully, especially the Changes page of your current

plan to see how benefits have changed from last year.

You can get brochures from the health plans. They

are also available on our web site at

www.opm.gov/insure. When it comes to your

health care, the best surprise is no surprise.

For more information on how to suspend your FEHB

enrollment, contact your retirement office at the

number listed on the back cover of this Guide.

Time limitations and other restrictions apply. For

instance, you must submit documentation that you are

suspending FEHB to enroll in a Medicare-sponsored

health plan or furnish proof of eligibility for coverage

under the Medicaid program or similar Statesponsored program of medical assistance for the

needy, in case you wish to reenroll in the FEHB Program at a later time.

If you had suspended FEHB coverage for either one

of these reasons (and had submitted the required

documentation) but now want to enroll in the FEHB

Program again, you may enroll during Open Season.

You may reenroll outside Open Season only if you

move out of the Medicare-sponsored health plan’s

service area, the Medicare-sponsored health plan is

discontinued, or you involuntarily lose coverage

under the Medicaid program or similar Statesponsored program of medical assistance for the

needy. If you cancelled your coverage for any other

reason, you cannot reenroll.

1

FEHB and You

Do not cancel your enrollment before reading this section.
Ü Choosing a plan

Cost — certainly the premium you pay is an important consideration, but there are some other things

you should consider. When thinking about premiums,

what can you afford biweekly or monthly? Should you

enroll in a High Option – and pay High Option premiums – if a Standard Option would do?

If you need to go to the hospital, how much will you

have to pay? Do you know how much you will pay

for an emergency room visit? If you have children,

what will it cost you for a well-child care visit?

Do you have to pay a deductible for the services you

might use? Your share of medical expenses is either a

coinsurance (a percentage of the bill) or a copayment

(a fixed dollar amount). Which option do you prefer

and what does the plan require? Does the plan limit

the dollar amount it will pay for certain services?

Coverage — check to see if the plan offers the services you think you might need. If you’re 65 or over,

how does the plan coordinate coverage with Medicare? If you regularly see an allergist, do you pay

extra for the allergy serum? Does the plan offer a prenatal program? Given the trend toward reducing hospital stays, will your plan pay for home health care?

Because health care is expensive, pay attention to the

plan’s catastrophic coverage to see how you are

protected. See if there are limits on the number of visits for the services you need.

How the plan works — if predictable cost, comprehensive benefits, no paperwork, and a coordinated

approach to health care are high priorities, consider a

Health Maintenance Organization (HMO). Most

HMOs require you to select a doctor to act as your

primary care physician, or PCP, who refers you to

specialists. If you don’t use a plan doctor, the plan

usually will not pay for services, unless it is an emergency.

A Plan offering a Point of Service (POS) Product also

has rules about doctor choice and access to specialists, but you can choose any doctor you like and see

specialists without referrals if you agree to pay more.

If you are willing to pay a little more in total costs for

the widest choice of doctors, a Fee-for-Service (FFS)

plan might be for you. FFS plans let you choose your

own doctor and allow you to see specialists without a

referral. Most FFS plans have Preferred Provider

Organizations (PPO) that save you money if you use

these providers.

Some plans offer 24-hour medical advice lines to help

you make health decisions. These programs try to

keep you healthy and avoid unnecessary – and potentially costly and time consuming – medical treatment.

Satisfaction — the experience of FEHB members

form the satisfaction ratings in this Guide. If you’re

considering joining a FFS plan, chances are you’ll file

a claim. How quickly does the plan process claims?

Will the plan be responsive to your questions? As an

HMO enrollee, you might be most interested in how

the plan is rated in access to care and choice of doctors. Ask the plan for its satisfaction ratings for the

past few years. Have the ratings changed much? Ask

your doctor’s office about experiences with different

health plans.

Accreditations — HMO accreditations reflect the

independent evaluations of nationally-recognized

organizations. Plans willing to go through an accreditation review show a commitment to continuous quality improvement and accountability.

2

FEHB and You
Ü Getting the most from a plan

Within any plan, there are things you can do to minimize your out-of-pocket costs and make the plan work

best for you.

Cost — an easy way to save money is to use your

plan’s mail order drug program, if it has one. Request

generic drugs instead of brand name drugs. Almost

all FFS Plans have Preferred Provider Organizations

(PPO, see definitions). Using a PPO will reduce your

out-of-pocket expenses. If you do not use a PPO provider, your plan will base its payment on a “usual and

customary” allowance which may be less than the actual billed charge. This means you might have to pay

the difference. You can reduce the chance of this happening by discussing fees in advance with your provider. Remember that plans set their own allowances.

It is also important to note that all of the services provided in a PPO hospital may not be covered by PPO

arrangements. Room and board will be covered, but

the anesthesia and radiology services may not be.

The only way to find out is to ask ahead of time.

Quality — talk openly with your health plan and providers about the kind of quality you want. Is your

HMO rated by a national accrediting organization?

Ask your surgeon how frequently (s)he performs the

procedure you’re considering and how the patients are

doing. If you’re pregnant, ask your obstetrician the

percentage of cases in which (s)he performs a

cesarian section. Is your doctor proposing a radical

approach to treatment when a more conservative one

is just as effective? Does your doctor tell you about

possible drug interactions with you when prescribing

a new medication?

No one has a greater stake in your health than you.

Understand how your plan works and don’t be shy

about asking questions. An informed consumer is a

better decision maker.

3

FEHB and You

✆ Call the FEHB Fraud Hot Line

(202) 418-3300

if a provider has billed you for services

you did not receive.
No waiting periods. Your retirement system sets the

effective date of your coverage. You can use your

FEHB benefits as soon as your coverage is effective

— there are no waiting periods, required medical

examinations or restrictions because of age or physical condition.

A choice of coverage. You can choose self

only coverage just for you, or self and

family coverage for you, your spouse, and

unmarried dependent children under age

22. Under certain circumstances, your FEHB enrollment may cover your disabled child 22 years old or

older who is incapable of self-support.

Ü A choice of plans and options.

l Managed Fee-for-Service plans

l Plans offering a Point of Service product

l Health Maintenance Organizations

A Government contribution. The Government contributes toward the total cost of

your premium. In 1999, the Government

will pay up to $1873.56 for each self only

enrollment and $4170.14 for each self and

family enrollment, but not more than 75% of the total

premium for any plan.

Deduction from your annuity payments for your

share. After the Government pays its share toward the

total premium, you pay the rest. Each plan’s premium

in this Guide is the amount that will be withheld in

1999. If the premium is more than your monthly annuity, you may either change to a lower cost plan or pay

the amount directly to your retirement office.

Even if you do not change your enrollment, your premium may change for the coming year. Premium

changes take effect January 1, 1999 and are reflected

in annuity payments beginning in February, 1999.

Annual opportunities to change plans. Each year

you have the opportunity to change plans. The 1998

Open Season is from November 9 through December

14, during which you may change plans or options, or

change from self only to self and family. (You may

change from self and family to self only at any time.)

Each year, in early November, your current health

benefits plan sends you a brochure, and your retirement office sends you instructions for ordering brochures and making Open Season changes. It is very

important that you keep your address up to date to

ensure that you receive your Open Season materials

each year. If you move, please be sure to let your

retirement office know your new address by calling

the number listed on the back cover of this Guide.

Your new plan will mail you an identification card. If

you need services before you receive your new card,

contact your new plan at the member services number

in your brochure.

If you decide not to change your enrollment, no action

by you is necessary.

Continued group coverage. The FEHB

Program offers continued FEHB coverage for you and your family when you

move, for your family if you die, or for

your former spouse if you divorce and

he or she has a qualifying court order (contact your

retirement office for more information).

Coverage after FEHB ends. The FEHB Program offers

either temporary continuation of FEHB coverage

(TCC) or conversion to non-group (private) coverage

for your covered dependent child if he or she marries

or turns age 22, or for your former spouse if you

divorce and he or she does not have a qualifying court

order (contact your retirement office for more information).

4

Program Features

Some of our important Program features are:
The Patient Bill of Rights and Responsibilities spells

out recommendations made by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. These recommendations promote and ensure health care quality and protect health care consumers. The President signed an

Executive memorandum directing us (the Office of

Personnel Management) to take steps to bring the

FEHB Program into contractual compliance with

these recommendations.

We are pleased to report that most FEHB plans

already comply with the Commission’s Patient Bill of

Rights and Responsibilities. For 1999, you can expect

all of the following from your FEHB plan:

l Direct access to women’s health care providers for routine and preventative women’s

health care services.

l Coverage of emergency department services

for screening and stabilization without

authorization if you have reason to believe

your life is endangered or you would be seriously injured or disabled.

l Direct access to a qualified specialist within

your network of providers if you have complex or serious medical conditions that need

frequent specialty care. Authorizations, when

required by a plan, will be for an adequate

number of direct access visits under an

approved treatment plan.

l Extensive information about plan characteristics and performance, provider network

characteristics, and care management.

l The elimination of “gag rules” in provider

contracts that could limit communication

about medically necessary treatment.

The health care system works best when enrollees

take the time to become informed. As responsible

consumers, you should:

l Read and understand your health benefits

coverage, limitations, and exclusions, health

plan processes, and procedures to follow

when seeking care.

l Work with your physician in developing and

carrying out a treatment plan.

l Practice healthy habits.

5

Patient Bill of Rights and Responsibilities
Brochure — A plan’s description of benefits, limitations, exclusions, and definitions under the FEHB

Program. You can get brochures from the health

plans. They are also available on our web site at

www.opm.gov/insure.

Catastrophic limit — The maximum amount of certain covered charges you have to pay out of your own

pocket during the year.

Coinsurance — How you and your FEHB plan split

the cost of covered medical expenses. For example, a

20% coinsurance means you pay 20% of most covered

charges. The plan pays 80%.

Copayment — A fixed dollar amount you pay as your

share of a service or benefit (sometimes called a

copay).

Covered charges — What the plan pays for. You’ll

find information about covered benefits, expenses and

services in each plan’s brochure.

Deductible — The amount of covered charges you

must pay before the plan begins to pay.

Health Maintenance Organization (HMO) — A health

plan that provides care through a network of physicians and hospitals in particular geographic or service

areas. HMOs coordinate the health care services you

receive. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where

you work. Some HMOs have agreements with providers in other service areas for non-emergency care if

you travel or are away from home for extended periods.

l The HMO provides a comprehensive set of

services — as long as you use the doctors and

providers in the HMO network. You may have

to pay something when you get care, for example, a $10 copayment per office visit.

l Most HMOs ask you to choose a doctor or

medical group to be your primary care provider

(PCP). Your PCP takes care of most of your

medical needs. In many HMOs, generally you

must get permission or a “referral” from your

PCP in order to see other providers in the network.

l Care received from a non-network provider,

other than emergency care, is generally not

covered.

6

Definitions and Explanations
Managed Fee-for-Service (FFS) Plan — A traditional

type of insurance that lets you use any doctor or hospital, but you usually must pay a deductible and coinsurance. These plans are called FFS because doctors

and other providers are paid for each service, such as

an office visit, or test. They help control costs by

managing some aspects of patient care. Most also provide access to PPOs.

Preferred Provider Organization (PPO) — A FFS

option where you can choose plan-selected providers who have agreements with the plan. When you

use a PPO provider, you pay less money out-ofpocket for medical service than when you use a

non-PPO provider.

Plans offering a Point of Service (POS) Product — A

product offered by an HMO or FFS plan that has features of both. In an HMO, the POS product lets you

use providers who are not part of the HMO network.

However, there is a greater cost associated with

choosing these non-network providers. You usually

pay deductibles and coinsurances that are substantially higher than the payments when you use a plan

provider. You will also need to file a claim for reimbursement, like in a FFS plan. The HMO plan wants

you to use its network of providers, but recognizes

that sometimes enrollees want to choose their own

provider.

In a FFS plan, the plan’s regular benefits include

deductibles and coinsurance. But in some locations,

the plan has set up a POS network of providers similar to what you would find in an HMO. The plan

encourages you to use these providers, usually by

waiving the deductibles and applying a copayment

that is smaller than the normal coinsurance. Generally, there is no paperwork when you use a network provider.

Provider — As used in this Guide and plan brochures,

a provider means an individual or institution that provides medical or health services, such as doctors, hospitals, nurse-midwives, or therapists. “Covered” providers are those the plan will reimburse.

7

Definitions and Explanations
Our 1999 FEHB web site gives current and valuable

information to help you choose a health plan. Visit us

at www.opm.gov/insure.

You will find even more information on our site this

year. The new Health Plan Profiler (HPP) lets you

view and print summary information about health

plans. Enrollees in some states can use a new interactive decision tool to narrow the health plan search.

You can download and print plan brochures and

other materials, access definitions by clicking

hyperlinks, and use automated links to navigate to

other sites. When you visit www.opm.gov/insure

you will see these choices and more:

l 1999 Plan Information – gives you access to

general information about plans, plan quality

indicators (including detailed survey results

which are not printed in this Guide), plan brochures, and information about how to choose

a plan. You can link to other web sites with

valuable information about health plans,

including those plans participating in the

FEHB Program. You also can view, download

and print the Guides to Federal Employees

Health Benefits Plans.

The Health Plan Profiler is an easy-to-use

web tool that lets you create plan profiles and

summaries. You also can link to FEHB plan

web sites from the Health Plan Profiler. Plans

that have a : in the column labeled “Web

site” in this Guide have their own web site.

l Annuitant Information – gives you general

information about Open Season for annuitants

as well as new features available to retirees,

including how to make Open Season changes

through the Internet. You can also link to the

Medicare web site.

l Patient Bill of Rights – gives you information

about the three objectives of the Patient Bill

of Rights and the eight principle areas of

rights and responsibilities. You can also link

to the full text of the Patient Bill of Rights

and related background information.

l Frequently Asked Questions – gives you

answers to questions about premiums, enrollment, family members, temporary continuation of coverage (TCC), switching plans,

retirement and other topics of interest.

8

Your Links to In formation

1999 FEHB Web Site — www.opm.gov/insure
Each year we ask a sample of Federal enrollees to rate

their satisfaction with their plans. We know this is an

important consideration for most people when choosing between plans. Ratings are included in this Guide

for most FEHB plans.

If a plan is not rated, it is because the plan is new to

the FEHB Program or the number of respondents was

too small for us to reliably include their opinions.

For more detailed information about ratings, visit our

web site at www.opm.gov/insure.

The categories shown in this Guide were chosen

because of their importance to most people in selecting a plan (some categories apply only to POS and

HMO plans or only to FFS plans):

l Ability to see the same doctor on most visits,

l Access to medical care (arranging for and

getting care),

l Access to medical care in an emergency (POS

and HMO only),

l Choice of doctors available through the plan

(being able to find doctors you are satisfied

with),

l Costs you personally have to pay (FFS only),

l Coverage (range of services covered),

l Explanation of care (what is wrong, what is

being done, and what to expect),

l Getting appointments when sick,

l Getting claims processed quickly (FFS only),

l Quality of care (from doctors and other medical professionals), and

l Results of care.

Overall Satisfaction. We also asked enrollees about

their overall satisfaction with their health plan.

A bar graph for each plan shows the percentage of

plan enrollees who indicated they were extremely satisfied, very satisfied or satisfied.

Example:

In the example, 19% of respondents are extremely satisfied, 45% are very satisfied, and 22% are satisfied.

The numbers in the bar add to 86, meaning 86% of

respondents were at least satisfied with the plan. The

remainder were less than satisfied with the plan overall.

Plans with an overall satisfaction score that is significantly higher than the average overall score are

identified with a ✔ in the column labeled “Top rated

plans”.

10

Quality Indicators

1998 Customer Satisfaction Survey Results

The Ratings. We survey enrollees and ask them to

rate various aspects of their health plan on a five

point scale of and

Plans that enrollees rated significantly better

than average in any category have a , average ratings get a , and significantly below average get

a . The average rating for all plans of the same

type is shown in the column heading.

poor, fair, good, very good, excellent.

19 45 22
www.medicare.gov

11

Dear Medicare Beneficiaries:

Recent legislation included Medicare+Choice, which will result in changes to the Medicare program. This new legislation will help keep Medicare well funded. Importantly, you now have

new preventive health benefits and new patient protections. In addition, starting in 1999, Medicare will offer new health plan choices. You may want to look at these choices.

It is very important for you to remember that if you are happy with the way you get your

health care now, you don’t have to do anything. The choice is yours. No matter what you

decide, you are still in the Medicare program and will receive all the Medicare covered

services.

If you are interested in changing the way you receive your care, one of the new Medicare

choices may be right for you. Caution: Changing the way you receive your health care is an

important decision. You may wish to ask your family, friends, or doctor for help. Special rules

may apply if you choose to disenroll from a Medicare health plan and return to the Original

Medicare Plan with other insurance coverage. Before you change your Medicare coverage, contact your retirement system. If you have Medicaid coverage, do not make changes until you contact the State Medical Assistance Office.

Whether you are new to the Medicare program or not, we want you to know of our deep commitment to keep Medicare working for you.

Donna E. Shalala Nancy-Ann Min DeParle

Secretary, Department of Administrator, Health Care

Health and Human Services Financing Administration

Medicare information is available on the Internet at www.medicare.gov. If you don’t have a computer, your

local public library or senior center may be able to help you

access the Medicare Web site.

In Partnership with the U.S. Department of Health and Human Services, the U.S. Office of

Personnel Management would like to share the following message about

Medicare & You:
12

Choosing a Health Plan?

Share Your Life.

SIGN YOUR DONOR CARD.

Share Your Decision.SM

TELL YOUR FAMILY.

For a free brochure and donor card, call the

Coalition on Donation at 1-888-90-SHARE

(1-888-907-4273) or visit the

U.S. Department of Health & Human Services web site:

www.organdonor.gov

Coalition on Donation

DID YOU KNOW?

About 58,000

Americans are

waiting for organ

transplants, and

about 4,000 die each

year while waiting.

There is no cost to

your family when

you become an organ

donor.

Your decision to

become an organ and

tissue donor will not

affect your medical

care because every

effort is made to save

your life before

donation occurs.

A national system is

in place to ensure

fair distribution of

organs without

regard to race,

gender, age, income

or celebrity status.

All major religious

groups in the U.S.

approve of and

support organ and

tissue donation.

To be an organ and

tissue donor, even if

you’ve put your

wishes in writing,

you must tell your

family members now

so they can carry out

your decision later.
7

Plan Report Cards

Nationwide Managed Fee-for Service Plans

(Pages 14 through 16)

Important: Some FFS plans also offer a POS product.

Check the POS section.
Nationwide

Managed

Fee-for-Service

Plans

Plan name

Telephone

number

Website

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

14

*Offers a Point of Service product.

† See your Personnel Office.

Plans open to all

Alliance Health Plan 202/939-6325 YQ1 YQ2 180.68 377.80 135.11 269.93

APWU Health Plan 800/222-2798 471 472 80.97 178.47 79.52 169.63

Blue Cross and Blue Shield local phone # 101 102 139.65 295.95 137.74 280.85 Service Benefit Plan-High 

Blue Cross and Blue Shield local phone # 104 105 50.31 122.59 60.28 135.03 Service Benefit Plan-Std* 

GEHA Benefit Plan* 800/821-6136 311 312 69.45 149.81 78.54 158.62

Mail Handlers-High 800/410-7778 451 452 73.65 148.55 84.26 159.53

Mail Handlers-Std 800/410-7778 454 455 39.55 85.84 41.53 90.13

NALC 703/729-4677 321 322 101.79 214.68 93.47 185.88

Postmasters-High 703/683-5585 361 362 248.41 536.06 250.84 530.58

Postmasters-Std* 703/683-5585 364 365 75.49 164.17 90.65 186.31

Plans open only to specific groups

Association Benefit Plan 800/634-0069 421 422 † † † †

Foreign Service 202/833-4910 401 402 56.03 175.50 64.50 188.96

Panama Canal Area 504/566-3501 431 432 56.55 124.33 49.86 108.14

Rural Carrier Benefit Plan 800/638-8432 381 382 65.16 115.94 73.80 121.23

SAMBA 301/984-1440 441 442 85.80 243.41 86.06 222.84

Secret Service 800/424-7474 Y71 Y72 41.64 98.69 47.89 113.49
15

*Copayment applies. See brochure for details.

** Scheduled Allowance.

Nationwide

Managed

Fee-for-Service

Plans

Plan name

Benefit

type

Plans open to all

Alliance Health Plan Non-PPO $300 $250 $3,000 $3,000 70% 70% 70% 70% 70% 70% 70% 100%

PPO $100 $150 $2,000 $2,000 90% 90% 90% 90% 90% 90% 90% 100%

APWU Health Plan Non-PPO $250 $200 $3,500 $3,500 70% 70% 70% 70% 70% 70% 70% 100%

PPO $250 None $2,000 $2,000 90% 90% 90% 90% 90% 90% 90% 100%

Blue Cross and Blue Shield Non-PPO $150 $100 $2,700 $2,700 100% 100% 80% 80% 80% * 80% 100%

Service Benefit Plan-High PPO $150 None $1,000 $1,000 100% 100% 95% 95% 95% * 95% 100%

Blue Cross and Blue Shield Non-PPO $200 $250 $3,750 $3,750 100% 100% 75% 75% 75% * 75% 100%

Service Benefit Plan-Std PPO $200 None $2,000 $2,000 100% 100% 95% 95% 95% * 95% 100%

GEHA Benefit Plan Non-PPO $250 None $3,500 $4,000 100% 80% 80% 80% 80% 80% 80% 100%

PPO $250 None $2,500 $3,000 100% 90% 90% 90% 90% 90% * 100%

Mail Handlers-High Non-PPO None $250 $3,000 $3,000 100% 100% 70%* 70% 70%* 70% 70% 100%

PPO None None $2,000 $2,000 100% 100% * * * * * 100%

Mail Handlers-Std Non-PPO $100 $300 $3,000 $3,000 100% 100% 70%* 70% 70%* 70% 70% 100%

PPO None $150 $3,000 $3,000 100% 100% 95%* * 95%* * * 100%

NALC Non-PPO $275 $100 $3,500 $3,500 80% 80% 70% 70% 70% 70% 70% 100%

PPO $275 None $3,000 $3,000 100% 100% 85% 80% 85% 80% 80% 100%

Postmasters-High Non-PPO $275 $150 $2,500 $2,500 100% 85% 85% 80% 85% 80% 80% 100%

PPO $200 None $2,500 $2,500 100% 100% 95% 95% 95% 95% 95% 100%

Postmasters-Std Non-PPO $300 $600 $6,700 $6,700 70% 70% 70% 70% 70% 70% 70% 100%

PPO $200 $350 $3,000 $3,000 100% 95% 95% 95% 95% 95% 95% 100%

Plans open only to specific groups

Association Benefit Plan Non-PPO $250 $100 $2,000 $2,000 80% 80% 80% 80% 80% 80% 80% 100%

PPO $250 None $2,000 $2,000 100% 100% 90% 90% 90% 90% 90% 100%

Foreign Service Non-PPO $250 $175 $2,500 $3,000 80% 85% 90% 80% 100% 80% 80% 100%

PPO $250 None $2,500 $3,000 100% 85% 90% 90% 100% 90% 90% 100%

Panama Canal Area Non-PPO None $125 $1,000 - 100% 80% 100% SA** 100% 75% 75% 100%

Rural Carrier Benefit Plan Non-PPO $250 $200 $2,500 $3,000 100% 80% 85% 75% 85% 75% 75% SA**

SAMBA Non-PPO $300 $200 $1,500 $2,000 70% 70% 70% 70% 70% 70% 70% 100%

PPO $200 $200 $1,500 $2,000 100% 95% 95% 95% 95% 100% 95% 100%

Secret Service Non-PPO $200 $100 $1,000 $2,000 100% 100% 80% 80% 80% 80% 80% 100%

Medical-surgical

You pay Plan pays

Inpatient care Outpatient care Catastrophic

Deductible limit Hospital Doctor Hospital Doctor

Calendar Inpatient Per Per Room & Accidental

year hospital person family board Other Surgeon Other Surgeon Other Tests injuries
16

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all Fee-for-Service plans in heading)

Nationwide

Managed

Fee-for-Service Plans

Plan name

Plan

code

Top

rated

plans

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

Coverage (93%)Access to care (92%)Choice of doctors (72%)When sick, can getappointment (83%)Quality of care (88%)Provider thorough and competent (88%)Explanation of care (85

%)

Results of care (84%)Plan handles yourquestions well (80%)Process claims quickly (97%)Costs you pay (85%)

Plans open to all

Alliance Health Plan* YQ 15 39 23 f * * * * * * * * * f

APWU Health Plan 47 26 35 22 * * * * * * * * * * *

Blue Cross and Blue Shield-High 10 31 49 10 h * h * * * * * * * h

Blue Cross and Blue Shield-Std 10 29 42 18 * * * * * * * * * h * ✔

GEHA Benefit Plan 31 36 40 18 h * * * * * * * * h h ✔

Mail Handlers-High 45 12 41 29 * * * * * * * * * f f

Mail Handlers-Std 45 14 35 25 f * * * * * * * * f f

NALC 32 17 37 20 f * f * * * * * * * f

Postmasters-High 36 23 40 22 * * * * * * * * * * f

Postmasters-Std 36 24 42 16 * * * * * * * * * f f

Plans open only to specific groups

Association Benefit Plan 42 31 43 17 * * h h * * * * * h h ✔

Foreign Service 40 38 37 14 h * * * * * * * * * h

Panama Canal Area 43

Rural Carrier Benefit Plan 38 25 44 20 * * h * * * * * h * h

SAMBA 44 23 43 18 * * f * * * * * * * *

Secret Service Y7 23 39 21 f * * * * * * * * * *

% satisfied with plan

*1997 Survey data
17

Plan Report Cards

Plans Offering Point of Service Product

(Pages 18 through 26)

Important: Some plans have been redesignated as HMOs.

If you do not find your plan in this section, 

check the HMO section.
Plans Offering a

Point of Service Product

Nationwide and by State

(Also check HMO Section)

Plan name – location

18

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Plans Offering a

Point of Service Product

Nationwide and by State

(Also check HMO Section)

Plan name – location

Nationwide

Postmasters-Std - All states 703/683-5585 364 365 75.49 164.17 90.65 186.31

Arizona

Health Plan of Nevada - Mohave County 702/871-0999 NM1 NM2 40.06 94.15 40.06 92.10

Arkansas

American HMO - Most of Arkansas 800/333-3534 RB1 RB2 40.08 98.14 39.94 97.84

QCA Health Plan - Most of Arkansas 800/235-7111 8Q1 8Q2 47.45 131.95 48.88 129.85

Colorado

HMO Colorado/Nevada - Most of Colorado 800/533-5643 L21 L22 43.26 124.33 45.19 112.98

Connecticut

Blue Cross and Blue Shield-Std - All of Connecticut 800/438-5356 104 105 50.31 122.59 60.28 135.03

Physicians Health Services/CT - All of Connecticut 800/848-4747 DP1 DP2 84.50 285.37 87.97 334.64

District of Columbia

Free State Health Plan - Washington, DC area 800/445-6036 LD1 LD2 55.02 127.25 51.72 186.55

Prudential HealthCare HMO - Washington, DC area 800/888-5447 JB1 JB2 55.90 129.33 49.97 110.00

United HealthCare Mid-Atlantic - Washington, DC/most of Maryland 410/277-9300 BL1 BL2 45.12 124.95 46.28 111.09

Georgia

Blue Cross and Blue Shield-Std - Athens/Atl/Augusta/Col/Macon/Savannah 800/282-2473 104 105 50.31 122.59 60.28 135.03

Hawaii

HMSA - All of Hawaii 808/948-6499 871 872 44.33 104.05 46.77 108.74

Illinois

American HMO - Chicago area/Central/South/Western IL 800/242-7460 AC1 AC2 45.79 131.19 46.68 112.04

Indiana

American HMO - Northwest Indiana 800/242-7460 AC1 AC2 45.79 131.19 46.68 112.04

Kansas

Blue Cross and Blue Shield-Std - Most of Kansas 800/432-0379 104 105 50.31 122.59 60.28 135.03

Louisiana

Blue Cross and Blue Shield-Std - New Orleans area 800/272-3029 104 105 50.31 122.59 60.28 135.03

Maxicare Louisiana - Baton Rouge/New Orleans areas 800/933-6294 JA1 JA2 38.71 90.10 40.65 94.61

Maryland

Free State Health Plan - All of Maryland 800/445-6036 LD1 LD2 55.02 127.25 51.72 186.55

Prudential HealthCare HMO - Most of Maryland 800/888-5447 JB1 JB2 55.90 129.33 49.97 110.00

United HealthCare Mid-Atlantic - Most of Maryland/Washington, DC 410/277-9300 BL1 BL2 45.12 124.95 46.28 111.09

Massachusetts

Blue Chip, Coord Hlth Partners - Southeastern Massachusetts 401/459-5500 DA1 DA2 46.59 168.85 48.02 144.24
Coverage (87%)

Access to care (91%)Access to care in anemergency (87%)Choice of doctor (84%)When sick, can get appointment (82%)Seeing same doctoron most visits (89%)Quality of care (91%)Provider thorough and competent (94%)Explanation of care (90%)Results of care (90%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Plans Offering a

Point of Service

Product

Nationwide and

by State

Plan name

19

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all plans offering a Point of Service product in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Nationwide

Postmasters-Std 

Arizona

Health Plan of Nevada 9 32 31 * f f f f f f f f f h

Arkansas

American HMO 19 32 27 f * * f * * * * * *

QCA Health Plan 

Colorado

HMO Colorado/Nevada* 19 36 34 * * * * h * * * * * h

Connecticut

Blue Cross and Blue Shield-Std 2

Physicians Health Services/CT 24 41 26 * h * h h * * * * * ✔ h

District of Columbia

Free State Health Plan 16 50 24 h * * * * * * * * * ✔ h

Prudential HealthCare HMO 8 37 29 * f f f * * f * f f *

United HealthCare Mid-Atlantic* 16 38 28 * f f f * * * * f *

Georgia

Blue Cross and Blue Shield-Std 2

Hawaii

HMSA 20 43 29 * h * h h h h * * * ✔

Illinois

American HMO 4 32 30 f f f f f f f f * f

Indiana

American HMO 4 32 30 f f f f f f f f * f

Kansas

Blue Cross and Blue Shield-Std

Louisiana

Blue Cross and Blue Shield-Std

Maxicare Louisiana 18 41 28 * f * * f * * * * *

Maryland

Free State Health Plan 16 50 24 h * * * * * * * * * ✔ h

Prudential HealthCare HMO 8 37 29 * f f f * * f * f f *

United HealthCare Mid-Atlantic* 16 38 28 * f f f * * * * f *

Massachusetts

Blue Chip, Coord Hlth Partners 14 41 34 * h * * h * * * * * h

*1997 Survey data
Plans Offering a

Point of Service Product

Nationwide and by State

(Also check HMO Section)

Plan name – location

20

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Massachusetts (continued)

Blue Cross and Blue Shield-Std - All of Massachusetts 800/433-7766 104 105 50.31 122.59 60.28 135.03

United HealthCare New England - All of Massachusetts 800/422-1404 VF1 VF2 58.74 175.72 65.89 185.30

Minnesota

Blue Cross and Blue Shield-Std - All of Minnesota 800/859-2128 104 105 50.31 122.59 60.28 135.03

Nebraska

GEHA Benefit Plan - Omaha area 800/821-6136 311 312 69.45 149.81 78.54 158.62

Nevada

Health Plan of Nevada - Las Vegas/Reno areas 702/871-0999 NM1 NM2 40.06 94.15 40.06 92.10

HMO Colorado/Nevada - Most of Nevada 800/438-5270 VS1 VS2 45.33 124.85 50.99 139.67

New Jersey

Blue Cross and Blue Shield-Std - All of New Jersey 800/624-5078 104 105 50.31 122.59 60.28 135.03

GHI Health Plan - Northern New Jersey 201/623-6000 801 802 46.98 161.53 50.27 155.14

New York

Blue Cross and Blue Shield-Std - NYC/LI/Rocklnd/Wstchstr/Mid-Hudson 800/522-5566 104 105 50.31 122.59 60.28 135.03

GHI Health Plan - All of New York 212/501-4444 801 802 46.98 161.53 50.27 155.14

Physicians Health Srvs of NY - NYC/LI/Dtchs/Orng/Putnm/Rklnd/Wschs 800/848-4747 PD1 PD2 99.43 325.13 129.44 398.67

North Carolina

QualChoice of North Carolina - Northwestern North Carolina 800/816-0911 7Q1 7Q2 42.67 107.32 45.92 111.79

North Dakota

Blue Cross and Blue Shield-Std - Fargo/Moorehead area 800/548-4026 104 105 50.31 122.59 60.28 135.03

Ohio

Blue Cross and Blue Shield-Std - Cincinnati area 888/818-4767 104 105 50.31 122.59 60.28 135.03

HealthFirst, Inc. - North Central Ohio 800/858-1472 RF1 RF2 43.72 138.41 49.73 160.51

Oklahoma

Blue Cross and Blue Shield-Std - Lawton/OK City/Tulsa/Other areas 800/722-3130 104 105 50.31 122.59 60.28 135.03

Pennsylvania

Free State Health Plan - Southern Pennsylvania 800/445-6036 LD1 LD2 55.02 127.25 51.72 186.55

Penn State Geisinger HlthPlan - Central/Northeastern Pennsylvania 717/271-8760 N91 N92 35.81 135.77 36.64 111.76

Puerto Rico

PCA Health Plans/Puerto Rico - All of Puerto Rico 787/282-7900 5P1 5P2 35.59 95.02 37.50 100.14

Triple-S - All of Puerto Rico 787/749-4777 891 892 43.94 94.38 46.14 99.10

United HealthCare Puerto Rico - All of Puerto Rico 787/782-5792 7U1 7U2 39.37 84.91 39.37 84.91

Rhode Island

Blue Chip, Coord Hlth Partners - All of Rhode Island 401/459-5500 DA1 DA2 46.59 168.85 48.02 144.24
Coverage (87%)

Access to care (91%)Access to care in anemergency (87%)Choice of doctor (84%)When sick, can get appointment (82%)Seeing same doctoron most visits (89%)Quality of care (91%)Provider thorough and competent (94%)Explanation of care (90%)Results of care (90%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Plans Offering a

Point of Service

Product

Nationwide and

by State

Plan name

21

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all plans offering a Point of Service product in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

*1997 Survey data

Massachusetts (continued)

Blue Cross and Blue Shield-Std h

United HealthCare New England* 25 40 27 * * * h * * * * h * ✔ 2

Minnesota

Blue Cross and Blue Shield-Std

Nebraska

GEHA Benefit Plan 

Nevada

Health Plan of Nevada 9 32 31 * f f f f f f f f f h

HMO Colorado/Nevada 21 49 23 * h * h h h h h h h ✔ h

New Jersey

Blue Cross and Blue Shield-Std

GHI Health Plan 16 36 34 f * * f h * * * * *

New York

Blue Cross and Blue Shield-Std h

GHI Health Plan 16 36 34 f * * f h * * * * *

Physicians Health Srvs of NY h

North Carolina

QualChoice of North Carolina 

North Dakota

Blue Cross and Blue Shield-Std

Ohio

Blue Cross and Blue Shield-Std 2

HealthFirst, Inc. 2

Oklahoma

Blue Cross and Blue Shield-Std

Pennsylvania

Free State Health Plan 16 50 24 h * * * * * * * * * ✔ h

Penn State Geisinger HlthPlan 24 44 20 * * * * * * * * * * 2

Puerto Rico

PCA Health Plans/Puerto Rico 

Triple-S 20 59 16 h * * h * h * * * h ✔

United HealthCare Puerto Rico 

Rhode Island

Blue Chip, Coord Hlth Partners 14 41 34 * h * * h * * * * * h
Plans Offering a

Point of Service Product

Nationwide and by State

(Also check HMO Section)

Plan name – location

22

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Rhode Island (continued)

United HealthCare New England - All of Rhode Island 800/422-1404 VF1 VF2 58.74 175.72 65.89 185.30

Texas

HMO Texas, L.C. - Houston/Beaumont areas 713/952-6868 2T1 2T2 41.76 108.62 39.98 99.77

Virginia

Prudential HealthCare HMO - Washington, DC area/Northern Virginia 800/888-5447 JB1 JB2 55.90 129.33 49.97 110.00

West Virginia

Free State Health Plan - Northeastern West Virginia 800/445-6036 LD1 LD2 55.02 127.25 51.72 186.55
Coverage (87%)

Access to care (91%)Access to care in anemergency (87%)Choice of doctor (84%)When sick, can get appointment (82%)Seeing same doctoron most visits (89%)Quality of care (91%)Provider thorough and competent (94%)Explanation of care (90%)Results of care (90%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Plans Offering a

Point of Service

Product

Nationwide and

by State

Plan name

23

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all plans offering a Point of Service product in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

*1997 Survey data

Rhode Island (continued)

United HealthCare New England* 25 40 27 * * * h * * * * h * ✔ 2

Texas

HMO Texas, L.C. 

Virginia

Prudential HealthCare HMO 8 37 29 * f f f * * f * f f *

West Virginia

Free State Health Plan 16 50 24 h * * * * * * * * * ✔ h
Plans Offering a

Point of Service Product

Nationwide 

and by State

Plan name Plan

code

In Network You Pay

Outpatient In-hospital

visits care

Per

Copay/ Copay/ admission

coinsurance Deductible coinsurance deductible

Out of Network You Pay

Outpatient In-hospital

Calendar visits care

year

deductible Per

(per person/ Copay/ Copay/ admission

family) coinsurance coinsurance deductible

Nationwide

Postmasters-Std 36 $10 None None $350 $300/$600 30% 30% $600

Arizona

Health Plan of Nevada NM $5 None $100 None $250/$750 20% 20% None

Arkansas

American HMO RB $5 None None None $200/$600 30% 30% None

QCA Health Plan 8Q $10 None None None $300/NA 20% 20% None

Colorado

HMO Colorado/Nevada L2 $10 None $200 None $250/$500 30% 30% None

Connecticut

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Physicians Health Services/CT DP $10 None None None $300/$750 20% 20% None

District of Columbia

Free State Health Plan LD $5 None None None $200/$400 20% 20% None

Prudential HealthCare HMO JB $5 None None None $150/$300 20% 20% None

United HealthCare Mid-Atlantic BL $5 None None None $250/$750 20% 20% None

Georgia

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Hawaii

HMSA 87 20% None None None $250/NA 30% 30% None

Illinois

American HMO AC None None None None $200/$600 30% None None

Indiana

American HMO AC None None None None $200/$600 30% None None

Kansas

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Louisiana

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Maxicare Louisiana JA $5 None None None $200/$600 20% 20% None

Maryland

Free State Health Plan LD $5 None None None $200/$400 20% 20% None

Prudential HealthCare HMO JB $5 None None None $150/$300 20% 20% None

United HealthCare Mid-Atlantic BL $5 None None None $250/$750 20% 20% None

Massachusetts

Blue Chip, Coord Hlth Partners DA $5 None None None $250/$500 20% 20% None

24
Plans Offering a

Point of Service Product

Nationwide 

and by State

Plan name Plan

code

In Network You Pay

Outpatient In-hospital

visits care

Per

Copay/ Copay/ admission

coinsurance Deductible coinsurance deductible

Out of Network You Pay

Outpatient In-hospital

Calendar visits care

year

deductible Per

(per person/ Copay/ Copay/ admission

family) coinsurance coinsurance deductible

Massachusetts (continued)

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

United HealthCare New England VF $10 None None None $200/$400 20% 20% None

Minnesota

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Nebraska

GEHA Benefit Plan 31 $5 None $75 None $175/$350 20% 20% None

Nevada

Health Plan of Nevada NM $5 None $100 None $250/$750 20% 20% None

HMO Colorado/Nevada VS $10 None $200 None $250/$500 30% 30% None

New Jersey

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

GHI Health Plan 80 $10 None None None None 50% 50% None

New York

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

GHI Health Plan 80 $10 None None None None 50% 50% None

Physicians Health Srvs of NY PD $10 None None None $300/$750 20% 20% None

North Carolina

QualChoice of North Carolina 7Q $10 None None None $300/$750 30% 30% None

North Dakota

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Ohio

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

HealthFirst, Inc. RF $5 None None None $250/$500 20% 20% None

Oklahoma

Blue Cross and Blue Shield-Std 10 $5 None None None $200/$400 25% None $250

Pennsylvania

Free State Health Plan LD $5 None None None $200/$400 20% 20% None

Penn State Geisinger HlthPlan N9 $10 None None None $250/$750 20% 20% None

Puerto Rico

PCA Health Plans/Puerto Rico 5P $5 None None None $100/$300 $8 None $50 

Triple-S 89 None None None None None 10% 10% None

United HealthCare Puerto Rico 7U $5 None None None $200/$400 20% 20% None

Rhode Island

Blue Chip, Coord Hlth Partners DA $5 None None None $250/$500 20% 20% None

25
Plans Offering a

Point of Service Product

Nationwide 

and by State

Plan name Plan

code

In Network You Pay

Outpatient In-hospital

visits care

Per

Copay/ Copay/ admission

coinsurance Deductible coinsurance deductible

Out of Network You Pay

Outpatient In-hospital

Calendar visits care

year

deductible Per

(per person/ Copay/ Copay/ admission

family) coinsurance coinsurance deductible

Rhode Island (continued)

United HealthCare New England VF $10 None None None $200/$400 20% 20% None

Texas

HMO Texas, L.C. 2T $5 None None None $500/$1500 30% 30% None

Virginia

Prudential HealthCare HMO JB $5 None None None $150/$300 20% 20% None

West Virginia

Free State Health Plan LD $5 None None None $200/$400 20% 20% None

26
27

Plan Report Cards

Health Maintenance Organization Plans

(Pages 28 through 55)

Important: Some plans have been redesignated as 

POS products. If you do not find your plan in 

this section, check the POS section.
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

28

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Alabama

Health Partners of Alabama - Birmingham/Other areas 800/888-7647 DF1 DF2 42.47 126.56 48.85 152.71

PrimeHealth of Alabama, Inc. - Central/Southern Alabama 800/236-9421 AA1 AA2 87.91 141.27 49.01 136.35

VIVA Health Plan - Northern/Central and Southern Cos 205/558-7474 4B1 4B2 43.74 129.11 53.50 145.10

Arizona

Aetna U.S. Healthcare - Phoenix/Tucson areas 800/537-9384 WQ1 WQ2 38.18 120.84 41.38 117.50

CIGNA HC of AZ-Phoenix - Phoenix area 800/572-9990 161 162 40.57 101.42 48.28 135.31

HealthPartners Health Plans - Central Arizona 602/664-2612 2S1 2S2 36.72 110.46 35.64 107.19

HealthPartners Health Plans - Tucson/Southern Arizona 602/664-2612 TD1 TD2 32.76 91.74 38.58 108.02

Humana Health Plan of AZ - Phoenix/Tucson/Southern Arizona 888/393-6765 DY1 DY2 33.70 91.67 41.38 112.54

Intergroup of Arizona, Inc. - Maricopa/Pima/Other AZ counties 800/289-2818 A71 A72 36.78 118.37 39.86 107.58

PacifiCare of Arizona - Counties surrounding Phoenix/Tucson 800/346-8600 7R1 7R2 0.00 0.00 45.11 157.80

PacifiCare of Arizona - Maricopa/Pima/Pinal Counties 800/347-8600 A31 A32 34.31 96.19 34.79 97.42

Premier HealthCare of Arizona - Graham/Greenlee/Maricopa/Pima/Pinal 800/914-4474 9A1 9A2 31.25 85.59 32.85 90.40

Premier HealthCare of Arizona - Yavapai/Mohave/Coconino/Yuma/Gila 800/914-4474 9B1 9B2 38.63 127.86 41.11 114.81

Arkansas

Prudential HealthCare HMO - Central and Northwest Arkansas 800/821-8787 VY1 VY2 43.73 97.49 61.34 137.30

California

Aetna U.S. Healthcare - Southern California 800/537-9384 2X1 2X2 43.40 101.57 45.45 106.36

Aetna U.S. Healthcare - Northern California area 800/537-9384 BU1 BU2 59.83 146.69 61.36 140.51

Blue Shield of CA Access+HMO - Most of California 800/334-5847 SJ1 SJ2 39.92 99.04 39.92 99.04

Blue Cross CaliforniaCare - Most of California 800/235-8631 M51 M52 36.01 91.87 40.15 102.44

CIGNA HealthCare of California - Northern/Southern California 800/832-3211 9T1 9T2 0.00 0.00 49.65 106.43

Health Net - Most of California 800/522-0088 LB1 LB2 40.82 95.90 43.52 103.00

Kaiser Permanente - Northern California 800/464-4000 591 592 38.78 92.56 43.49 103.83

Kaiser Permanente - Southern California 800/464-4000 621 622 44.22 103.81 48.04 111.05

Maxicare Southern California - Southern California 800/234-6294 CM1 CM2 32.04 81.09 36.07 91.29

National HMO Health Plan - Northern/Central/Southern California 800/468-8600 MN1 MN2 37.38 99.35 38.58 102.05

Omni Healthcare - Central Valley and Sacramento areas 800/342-8462 HN1 HN2 43.79 132.36 48.27 138.17

PacifiCare of California - Most of California 800/624-8822 CY1 CY2 41.00 116.35 40.49 104.95

United Health Plan - LA/Orange/San Bernardino Counties 800/544-0088 C41 C42 31.49 68.17 35.30 76.43

Western Health Advantage - Northern California 888-563-2250 5Z1 5Z2 0.00 0.00 41.76 100.22

Colorado

Aetna U.S. Healthcare - The Front Range 800/537-9384 6F1 6F2 38.07 101.36 39.97 106.42

Antero HealthPlans - Central Colorado 800/456-9292 9X1 9X2 34.65 94.04 34.65 94.04
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

29

Alabama

Health Partners of Alabama 20 48 22 h h * h h h h h h h ✔

PrimeHealth of Alabama, Inc. 11 36 28 f * * * f * * h * *

VIVA Health Plan 

Arizona

Aetna U.S. Healthcare 13 35 21 * * * * f * * * * *

CIGNA HC of AZ-Phoenix 21 43 21 h * * * f f * * * * 2

HealthPartners Health Plans 12 38 25 f f * * * * * * * * 2

HealthPartners Health Plans 16 42 23 * * * * f * f f f f 2

Humana Health Plan of AZ 17 30 23 * f * * f * f * f f

Intergroup of Arizona, Inc. 13 39 28 * f f f f f f f f f 2

PacifiCare of Arizona 2

PacifiCare of Arizona 14 30 26 f f f f f f f f f f 2

Premier HealthCare of Arizona 

Premier HealthCare of Arizona 

Arkansas

Prudential HealthCare HMO 2

California

Aetna U.S. Healthcare 10 31 29 * f * * f f f * f f

Aetna U.S. Healthcare 11 38 28 * * * * * h * * * * 2

Blue Shield of CA Access+HMO 14 33 33 * f f f * * f f f f h

Blue Cross CaliforniaCare 16 39 27 * * * f * * f * f * 2

CIGNA HealthCare of California 11 37 26 f f f f * * f f f f 2

Health Net 14 40 32 * * * * * * * * * * h

Kaiser Permanente 15 44 27 * f f * * f * f f * h

Kaiser Permanente 19 47 20 h * * * f f * * f * 2

Maxicare Southern California 14 29 30 f f f f f f f f f f

National HMO Health Plan* 11 48 20 f * f * * * * * * *

Omni Healthcare 21 32 31 * * * * * * * * * *

PacifiCare of California* 18 35 27 * f * * f * f f f f 2

United Health Plan !*

Western Health Advantage 

Colorado

Aetna U.S. Healthcare 

Antero HealthPlans 

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (8%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

30

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Colorado (continued)

CIGNA HealthCare of CO - Front Range area 800/832-3211 1C1 1C2 43.14 105.95 45.63 109.51

Kaiser Permanente - Denver/Colorado Springs areas 303/338-3800 651 652 39.26 100.26 43.19 110.26

PacifiCare of Colorado-High - Denver/Pueblo/Col.Springs/Fort Collins 800/877-9777 D61 D62 38.84 100.49 42.33 109.53

PacifiCare of Colorado-Std - Denver/Pueblo/Col.Springs/Fort Collins 800/877-9777 D64 D65 34.45 89.28 33.70 87.32

QualMed of Colorado - Denver/Boulder/Colorado Springs/Pueblo 800/847-3990 2D1 2D2 37.15 94.42 44.86 113.84

Rocky Mountain HMO - Most of Colorado 800/346-4643 881 882 54.65 153.75 79.60 203.82

Connecticut

Aetna U.S. Healthcare - All of Connecticut 800/537-9384 H11 H12 86.28 307.52 80.99 290.10

ConnectiCare - All of Connecticut 800/251-7722 TE1 TE2 111.02 255.63 49.84 110.75

Harvard Community Hlth Plan - Northwest Connecticut 888/333-4742 681 682 78.70 279.00 70.55 253.22

Health New England - Northern Connecticut 413/787-4004 DJ1 DJ2 61.97 144.52 64.37 139.80

Kaiser Permanente - Most of Connecticut 800/597-3872 DM1 DM2 50.70 156.41 61.77 175.91

Prudential HealthCare HMO - Fairfield/Litchfield/New Haven Cos. 800/422-7399 8C1 8C2 51.03 305.09 109.11 309.19

Delaware

Aetna U.S. Healthcare - All of Delaware 800/537-9384 NK1 NK2 107.88 389.20 103.18 372.11

AmeriHealth HMO, Inc. - All of Delaware 800/444-6282 SP1 SP2 48.93 196.93 53.78 203.54

District of Columbia

Aetna U.S. Healthcare - Washington, DC area 800/537-9384 V81 V82 64.03 197.49 74.21 215.50

CapitalCare - Washington, DC area 800/680-9495 2G1 2G2 39.80 129.57 56.83 238.16

George Washington Univ HP-High - Washington, DC area 301/941-2000 E51 E52 83.49 187.48 73.75 155.33

George Washington Univ HP-Std - Washington, DC area 301/941-2000 E54 E55 36.97 80.60 42.27 92.05

Kaiser Permanente - Washington, DC area 301/468-6000 E31 E32 42.82 114.73 47.30 119.75

MD-IPA - Washington, DC area 800/331-2102 JP1 JP2 42.84 103.03 50.46 136.91

NYLCare/Mid-Atlantic-High - Washington, DC area 800/635-3121 JN1 JN2 52.22 150.33 50.47 126.97

NYLCare/Mid-Atlantic-Std - Washington, DC area 800/635-3121 JN4 JN5 33.24 78.10 35.67 83.82

Florida

Aetna U.S. Healthcare - Central and South Florida areas 800/537-9384 8A1 8A2 50.08 226.98 57.83 245.94

Av-Med Health Plan - Broward/Dade/Palm Beach Counties 800/882-8633 EM1 EM2 38.56 115.83 43.00 125.47

Av-Med Health Plan - Orlando area 800/882-8633 GP1 GP2 38.91 119.80 41.95 115.35

Av-Med Health Plan - Tampa Bay area 800/882-8633 H51 H52 45.03 186.99 41.92 115.27

Av-Med Health Plan - Jacksonville area 800/882-8633 HW1 HW2 40.11 132.97 42.94 124.78

Av-Med Health Plan - Gainesville area 800/882-8633 JF1 JF2 40.32 135.31 46.17 160.44

Beacon Health Plan - Dade/Broward/Palm Beach Counties 800/850-0979 4K1 4K2 32.02 89.68 36.84 103.20

Capital Health Plan - Tallahassee area 850/383-3311 EA1 EA2 39.91 118.13 40.74 108.78
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

31

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data

Colorado (continued)

CIGNA HealthCare of CO 2

Kaiser Permanente 25 46 19 h * * * * f * * * * ✔ 2

PacifiCare of Colorado-High 14 43 25 * * h * * h * * * * 2

PacifiCare of Colorado-Std 10 35 31 f * * f * * f f f * 2

QualMed of Colorado h

Rocky Mountain HMO 14 54 20 * h h h * * * * * * ✔ h

Connecticut

Aetna U.S. Healthcare 11 37 28 * * * * h h * * * * h

ConnectiCare 25 46 21 h * * h h h h * h h ✔ h

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

Health New England 13 53 24 h * * h * h h * * h ✔ *

Kaiser Permanente 18 41 29 * * * * * * * * * * ✔ 2

Prudential HealthCare HMO 2

Delaware

Aetna U.S. Healthcare 15 33 31 * * * * * * * * * *

AmeriHealth HMO, Inc. 15 31 29 * * * * * * * * * * h

District of Columbia

Aetna U.S. Healthcare 11 36 31 * * * * * * * * * * 2

CapitalCare 20 36 29 * h * * * * * * * *

George Washington Univ HP-High 18 40 25 h * * * * f * * * * h

George Washington Univ HP-Std 13 31 33 * * f * * f * * * * h

Kaiser Permanente* 23 39 24 h * f * * f f * f * 2

MD-IPA 15 45 30 * * * * * h h * h h ✔ 2

NYLCare/Mid-Atlantic-High 17 42 23 * * * * * * * * * * 2

NYLCare/Mid-Atlantic-Std 11 41 31 * * * * * * * * * * 2

Florida

Aetna U.S. Healthcare 2

Av-Med Health Plan 25 42 21 * * * * * * * * * * ✔ 2*

Av-Med Health Plan 24 35 23 * * * * * * * * * * 2*

Av-Med Health Plan 19 37 27 * * * f * * f f * * 2*

Av-Med Health Plan 27 43 16 * * * * * * * * * * 2*

Av-Med Health Plan 26 45 17 * * * * * * * * * * ✔ 2*

Beacon Health Plan 

Capital Health Plan 39 37 13 * * h h * h h h * h h
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

32

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Florida (continued)

Foundation Health - Northern Florida 800/441-5501 5C1 5C2 27.52 77.78 39.67 111.99

Foundation Health - Central Florida 800/441-5501 5D1 5D2 30.02 84.82 43.40 141.49

Foundation Health - Southern Florida 800/441-5501 5E1 5E2 23.22 65.59 37.47 103.02

Health Options - Tampa Bay area 800/583-9072 D71 D72 40.98 131.37 47.69 158.73

Health Options - Palm Beach/Martin Counties 800/964-6595 FN1 FN2 39.65 116.31 42.33 113.31

Health Options - Broward/Dade Counties 800/964-6595 FR1 FR2 37.05 100.01 37.48 101.18

HIP Health Plan of FL - South Florida/Tampa Bay areas 800/385-4447 K71 K72 44.35 188.44 42.58 128.36

Humana Medical Plan - Orlando/Gainesville areas 888/393-6765 7F1 7F2 34.96 97.93 39.61 110.91

Humana Medical Plan - Southeast/Southcentral/Southwest Florida 888/393-6765 EE1 EE2 40.95 102.38 45.30 113.26

Humana Medical Plan - Tampa Bay area 888/393-6765 JH1 JH2 40.41 101.03 45.93 114.83

Humana Medical Plan - Jacksonville area 888/393-6765 P51 P52 39.03 128.98 50.40 156.41

Humana Medical Plan - Daytona area 888/393-6765 P71 P72 39.61 135.40 50.34 155.94

PCA Family Health Plan of FL - Most of Florida 888/393-6765 FQ1 FQ2 31.82 95.48 33.53 100.61

PCA Health Plans of Florida - Most of Florida 888/393-6765 PJ1 PJ2 31.82 95.48 33.53 100.61

Prudential HealthCare HMO - Jacksonville area 904/351-8386 EC1 EC2 33.28 91.54 35.81 98.48

Prudential HealthCare HMO - Central Florida area 800/628-3801 EH1 EH2 33.42 93.59 40.00 111.97

Prudential HealthCare HMO - Broward/Dade/Palm Beach Counties 800/457-3885 HE1 HE2 35.88 100.48 46.44 172.49

United HealthCare of Florida - South Florida/Tampa areas 800/543-3145 QK1 QK2 61.84 234.35 48.88 170.67

Georgia

Aetna U.S. Healthcare - Atlanta/Augusta/Athens/Macon areas 800/537-9384 2U1 2U2 41.32 117.89 45.25 119.13

Athens Area Health Plan Select - Athens metro area 706-549-0549 8Y1 8Y2 0.00 0.00 42.26 108.44

Kaiser Permanente - Atlanta area 800/255-0568 F81 F82 42.37 122.05 45.61 115.78

Prudential HealthCare HMO - Atlanta/Macon areas 800/738-1728 EZ1 EZ2 34.08 93.24 37.66 103.04

Guam

Guam Memorial Health Plan-High - Guam/Palau/N. Mariana Islands 671/646-4647 ZA1 ZA2 54.58 186.34 63.90 210.23

Guam Memorial Health Plan-Std - Guam/Palau/N. Mariana Islands 671/646-4647 ZA4 ZA5 36.22 101.62 40.35 114.89

Health Maintenance Life - Guam 671/646-7826 281 282 36.37 127.38 33.30 99.45

PacifiCare Asia Pacific - Guam 671/647-3471 JK1 JK2 55.02 214.94 46.45 142.27

Hawaii

Kaiser Permanente-High - Islands of Hawaii/Maui/Oahu/Kauai 808/597-5955 631 632 87.99 188.18 85.58 172.19

Kaiser Permanente-Std - Islands of Hawaii/Maui/Oahu/Kauai 808/597-5955 634 635 46.63 100.25 51.01 109.68

Idaho

Group Health Cooperative - Benewah/Bonner/Kootenai/Latah/Shoshone 800/497-2210 VR1 VR2 63.31 217.32 63.38 217.60

HealthPlus - Washington border counties 800/527-6675 8F1 8F2 0.00 0.00 48.29 134.55
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

33

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data

Florida (continued)

Foundation Health 2

Foundation Health 2

Foundation Health 2

Health Options 13 34 33 * * * * * * * h h h 2

Health Options 2

Health Options 10 35 34 * * * * f * f f f f 2

HIP Health Plan of FL 14 34 25 * * * * f f f f f f 2

Humana Medical Plan 10 34 33 * f f f f f f f f f 2

Humana Medical Plan 14 30 33 f f f f f f f f f f 2

Humana Medical Plan 14 37 26 * f * f f f f f f f 2

Humana Medical Plan 13 37 30 * * * f f * * * * * 2

Humana Medical Plan 12 31 30 * * * f f * f * f f 2

PCA Family Health Plan of FL h

PCA Health Plans of Florida 10 25 27 f f * f f * f f f f h

Prudential HealthCare HMO 30 35 21 * * * * * * h * * * 2

Prudential HealthCare HMO 19 42 23 * * * * * f * * * * 2

Prudential HealthCare HMO 16 28 34 * f * * f * f f f f 2

United HealthCare of Florida 

Georgia

Aetna U.S. Healthcare 15 35 27 * * * * * * * * * *

Athens Area Health Plan Select

Kaiser Permanente 22 40 25 * * * * h f * * * * ✔ 2

Prudential HealthCare HMO 11 34 32 * f f f f f f * * * h

Guam

Guam Memorial Health Plan-High 7 32 43 f f f * f f f f f f

Guam Memorial Health Plan-Std 

Health Maintenance Life* 15 47 25 f f f * * f * f * *

PacifiCare Asia Pacific* 12 33 35 f f f f f f f f f f

Hawaii

Kaiser Permanente-High 26 40 22 * * * * * h * * * * ✔ 2

Kaiser Permanente-Std 16 36 35 * * * * h * * * * * 2

Idaho

Group Health Cooperative 15 33 31 * * h * h * * * * * 2

HealthPlus 
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

34

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Illinois

Aetna U.S. Healthcare - Chicago area 800/537-9384 XC1 XC2 37.49 165.08 38.73 141.53

BCI HMO, Inc. - Chicago/Rockford/Springfld/Downstate Cos 800/772-6897 3B1 3B2 68.10 224.01 71.76 227.33

Group Health Plan - Southern/Metro East/Central 800/743-3901 MM1 MM2 72.96 231.38 57.11 185.51

Health Alliance HMO - Central/E.Central/N.West/South/West IL 800/851-3379 FX1 FX2 50.16 142.42 63.98 166.25

Health Partners of the Midwest - St. Louis area 800/338-4123 RN1 RN2 45.21 98.22 71.91 147.29

Heritage National Healthplan - Bloomingtn/Joliet/Moline/Peoria/RockIsld 800/247-9110 3J1 3J2 46.66 106.78 49.26 184.49

Humana Health Plan Inc. - Chicago area 888/393-6765 751 752 44.07 129.68 52.24 152.58

John Deere Family Healthplan - Quad Cities 800/247-9110 1J1 1J2 39.12 92.40 43.93 126.93

Mercy Health Plans/Premier - Southwest Illinois 800/327-0763 7M1 7M2 47.80 135.31 47.76 111.09

OSF HealthPlans - Central/Northern Illinois 800/673-5222 9F1 9F2 37.61 99.65 44.12 116.63

PersonalCare’s HMO - East Central Illinois 800/431-1211 GE1 GE2 40.78 111.13 41.79 107.46

Principal St.Louis - St. Louis area 800/966-3938 121 122 46.73 101.87 80.36 168.01

Prudential HealthCare HMO - Southern Illinois 800/298-7625 VZ1 VZ2 37.22 94.04 37.95 95.85

Rush Prudential HMO - Chicago area 312/234-7747 171 172 38.83 93.42 46.46 111.77

Union Health Service - Chicago area 312/829-4224 761 762 41.48 103.20 43.39 107.61

United HealthCare Select - St. Louis and Metro East 800/627-0607 H81 H82 48.45 132.04 51.32 124.82

Indiana

Aetna U.S. Healthcare - Southern Indiana 800/537-9384 RD1 RD2 47.80 153.60 52.00 161.64

Aetna U.S. Healthcare - Lake/Porter Counties 800/537-9384 XC1 XC2 37.49 165.08 38.73 141.53

Arnett HMO - Lafayette area 765/448-7440 G21 G22 65.50 233.59 63.55 223.67

BCI HMO, Inc. - Lake County 800/772-6897 3B1 3B2 68.10 224.01 71.76 227.33

Health Alliance HMO - Fountain/Vermillion/Warren Counties 800/851-3379 FX1 FX2 50.16 142.42 63.98 166.25

Humana Care Plan - Southern Indiana 888/393-6765 181 182 46.33 171.93 54.10 178.10

Humana Health Plan Inc. - Lake and Porter Counties 888/393-6765 751 752 44.07 129.68 52.24 152.58

Humana Health Plan - Southern Indiana 888/393-6765 D21 D22 47.00 178.95 55.01 180.33

Maxicare Indiana - Most of Indiana 800/441-3355 GK1 GK2 42.39 99.80 46.73 110.02

PARTNERS Nat’l HPs of IN - Northern Indiana 800/967-5439 MC1 MC2 43.46 145.47 43.61 113.80

Physicians HP of N. Indiana - Northern Indiana 219/432-6690 DQ1 DQ2 51.59 130.72 63.38 147.62

Prudential HealthCare Midwest - Dearborn County 800/932-7478 S31 S32 39.05 101.43 41.70 108.29

Rush Prudential HMO - Lake/Porter Counties 888/234-7747 171 172 38.83 93.42 46.46 111.77

The M*Plan - Central/Northeast/Southwest Indiana 800/816-7526 IN1 IN2 41.20 100.21 49.86 107.55

United HealthCare of Kentucky - Clark/Floyd/Harrison Counties 800/495-5283 DU1 DU2 56.90 186.90 50.09 149.03

Welborn HMO - Evansville area 812/426-6600 H31 H32 44.66 153.51 45.41 122.05
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

35

Illinois

Aetna U.S. Healthcare 5 30 32 * * f f * * * * f f 2

BCI HMO, Inc. 13 36 31 * * * * * * * * * *

Group Health Plan* 15 48 25 * * * * * * * * * * *

Health Alliance HMO 25 46 15 * * h * * h h * * h

Health Partners of the Midwest 18 43 23 h * * h * * * * * *

Heritage National Healthplan 

Humana Health Plan Inc. 13 29 37 f f f f f f f f f f 2

John Deere Family Healthplan 

Mercy Health Plans/Premier 

OSF HealthPlans 

PersonalCare’s HMO 17 40 34 * * * * * h * * * * ✔

Principal St.Louis 20 45 25 h * h h * * * * * * ✔ h

Prudential HealthCare HMO 2

Rush Prudential HMO 17 37 26 * * f * f * * * * * 2

Union Health Service 

United HealthCare Select 17 41 27 * * * * h h * * * *

Indiana

Aetna U.S. Healthcare 11 29 30 * * * * * * * h * *

Aetna U.S. Healthcare 5 30 32 * * f f * * * * f f

Arnett HMO 

BCI HMO, Inc. 13 36 31 * * * * * * * * * *

Health Alliance HMO 25 46 15 * * h * * h h * * h

Humana Care Plan 15 37 28 * * * f * * * * * *

Humana Health Plan Inc. 13 29 37 f f f f f f f f f f 2

Humana Health Plan 15 42 28 * * * h * * * * * *

Maxicare Indiana 16 41 23 * * * * * * * * * * !

PARTNERS Nat’l HPs of IN *

Physicians HP of N. Indiana 

Prudential HealthCare Midwest 12 46 27 * * * h * * * * * * 2

Rush Prudential HMO 17 37 26 * * f * f * * * * * 2

The M*Plan 22 47 19 * h * * h * h h h h ✔ 2

United HealthCare of Kentucky 

Welborn HMO 34 39 20 h h h h h * * * * * ✔ h Coverage (77%) Access to care (81%) Access to care in an emergency (86%) Choice of doctor (73%) When sick, can get appointment (79%) Seeing same doctor on most visits (84%) Quality of care (76%) Provider thorough and competent (82%) Explanation of care (80%) Results of care (74%)

Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

36

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Iowa

Care Choices - Northwest Iowa 800/535-6252 FA1 FA2 41.19 134.99 48.48 174.14

Exclusive Healthcare - Council Bluffs/Sioux City areas 800/456-9292 9Y1 9Y2 38.59 108.68 48.08 175.00

Health Alliance HMO - Central Iowa 888/536-5300 7X1 7X2 42.50 101.25 44.62 108.22

Heritage National Healthplan - Central/Eastern Iowa 800/247-9110 3J1 3J2 46.66 106.78 49.26 184.49

John Deere Family Healthplan - Des Moines/Waterloo/Quad Cities areas 800/247-9110 1J1 1J2 39.12 92.40 43.93 126.93

Principal Health Care of Iowa - Des Moines/Central Iowa/Waterloo 800/257-4692 SV1 SV2 42.06 146.06 43.74 124.98

SecureCare of Iowa - Central and Eastern Iowa areas 888/881-8820 3Q1 3Q2 34.22 89.63 37.29 97.69

United HealthCare/Midlands - Western Iowa 402/445-5700 NF1 NF2 43.82 117.96 48.04 108.71

Kansas

Humana Kansas City, Inc.-High - Kansas City area 888/393-6765 MS1 MS2 45.60 129.57 49.99 132.47

Humana Kansas City, Inc.-Std - Kansas City area 888/393-6765 MS4 MS5 42.35 101.63 46.57 111.76

Kaiser Permanente - Kansas City area 913/642-2662 HA1 HA2 33.87 87.39 37.97 97.95

Preferred Plus of Kansas - S. Central & Jefferson/Shawnee Counties 800/660-8114 VA1 VA2 47.51 201.35 50.30 187.68

Principal Health Care of KC - Wichita/Salinas areas 800/969-3343 7W1 7W2 54.60 185.49 49.38 156.18

Prudential HealthCare HMO - Kansas City/Topeka areas 800/441-5588 1K1 1K2 42.33 128.23 48.82 120.30

United HealthCare MidWest - Kansas City/Topeka areas 800/357-0975 4M1 4M2 51.55 180.94 62.62 202.85

Kentucky

Advantage Care, Inc. - Central/Eastern Kentucky 800/850-8585 XW1 XW2 44.72 156.44 63.64 223.39

Aetna U.S. Healthcare - Lexington/Louisville areas 800/537-9384 RD1 RD2 47.80 153.60 52.00 161.64

Bluegrass Family Health - Central/Eastern Kentucky 606/269-4475 2B1 2B2 45.37 121.73 46.63 110.79

Humana Care Plan - Louisville area 888/393-6765 181 182 46.33 171.93 54.10 178.10

Humana Care Plan - Lexington area 888/393-6765 HR1 HR2 39.16 136.61 48.17 134.16

Humana Health Plan - Lexington/Louisville 888/393-6765 D21 D22 47.00 178.95 55.01 180.33

PacifiCare of Ohio, Inc. - Northern Kentucky 800/824-0428 R81 R82 45.53 121.75 48.13 113.10

Prudential HealthCare Midwest - Northern Kentucky 800/932-7478 S31 S32 39.05 101.43 41.70 108.29

United Health Care of Ohio - Northern Kentucky 800/231-2918 3U1 3U2 53.33 132.47 64.52 159.92

United HealthCare of Kentucky - Most of Kentucky 800/495-5283 DU1 DU2 56.90 186.90 50.09 149.03

Louisiana

Aetna U.S. Healthcare - New Orleans area 800/537-9384 NG1 NG2 40.58 113.75 43.77 113.79

Aetna U.S. Healthcare - Baton Rouge/Lafayette areas 800/537-9384 TK1 TK2 33.52 127.53 36.16 122.51

Gulf South Health Plan, Inc. - Baton Rouge/New Orleans/Lafayette area 504/237-1700 LY1 LY2 39.16 98.87 47.90 136.26

Smartplan - All of Louisiana 800/259-7370 8D1 8D2 0.00 0.00 43.36 113.30

Vantage Health Plan - Monroe/North Louisiana 318/323-9779 7V1 7V2 44.76 144.87 48.72 145.73
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

37

Iowa

Care Choices 

Exclusive Healthcare 15 40 29 * h * * * * * * h *

Health Alliance HMO 

Heritage National Healthplan 

John Deere Family Healthplan 

Principal Health Care of Iowa* 17 36 30 * * * * * * * * * * h

SecureCare of Iowa 

United HealthCare/Midlands 20 33 28 * * * * h * * * * * 2

Kansas

Humana Kansas City, Inc.-High 22 37 24 * * * * * * * * * * 2

Humana Kansas City, Inc.-Std 2

Kaiser Permanente 18 35 25 * * f f * f f f f f 2

Preferred Plus of Kansas 

Principal Health Care of KC h

Prudential HealthCare HMO 11 42 24 * * * * * * * * h * 2

United HealthCare MidWest* 13 46 24 h * * h * h * h * *

Kentucky

Advantage Care, Inc. 2

Aetna U.S. Healthcare 11 29 30 * * * * * * * h * *

Bluegrass Family Health 21 39 26 * * * * * * * * * *

Humana Care Plan 15 37 28 * * * f * * * * * *

Humana Care Plan 20 36 26 * * * * h f * * * *

Humana Health Plan 15 42 28 * * * h * * * * * *

PacifiCare of Ohio, Inc. 9 37 28 f * * * * * * * * *

Prudential HealthCare Midwest 12 46 27 * * * h * * * * * * 2

United Health Care of Ohio 12 40 30 * h * h * h h h * * 2

United HealthCare of Kentucky 

Louisiana

Aetna U.S. Healthcare 14 42 27 * * * * f * * * * *

Aetna U.S. Healthcare 

Gulf South Health Plan, Inc. 2

Smartplan 

Vantage Health Plan 

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

38

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Maine

Harvard Community Hlth Plan - Southeastern Maine 888/333-4742 681 682 78.70 279.00 70.55 253.22

NYLCare Health Plans of Maine - All of Maine 800/895-6667 9M1 9M2 56.97 163.43 62.03 138.99

Maryland

Aetna U.S. Healthcare - North/Central MD & Washington, DC area 800/537-9384 V81 V82 64.03 197.49 74.21 215.50

CapitalCare - South/Central Maryland 800/680-9495 2G1 2G2 39.80 129.57 56.83 238.16

George Washington Univ HP-High - Central/Southern Maryland 301/941-2000 E51 E52 83.49 187.48 73.75 155.33

George Washington Univ HP-Std - Central/Southern Maryland 301/941-2000 E54 E55 36.97 80.60 42.27 92.05

Kaiser Permanente - Baltimore/Washington, DC areas 301/468-6000 E31 E32 42.82 114.73 47.30 119.75

MD-IPA - All of Maryland 800/331-2102 JP1 JP2 42.84 103.03 50.46 136.91

NYLCare/Mid-Atlantic-High - North/Central/Southern Maryland 800/635-3121 JN1 JN2 52.22 150.33 50.47 126.97

NYLCare/Mid-Atlantic-Std - North/Central/Southern Maryland 800/635-3121 JN4 JN5 33.24 78.10 35.67 83.82

Massachusetts

Aetna U.S. Healthcare - Central/Eastern MA/Hampden 800/537-9384 NE1 NE2 68.49 262.04 73.65 273.18

Fallon Community Health Plan - Central/Eastern Massachusetts 800/868-5200 JV1 JV2 41.25 118.63 43.35 111.84

Harvard Community Hlth Plan - Eastern/Western Massachusetts 888/333-4742 681 682 78.70 279.00 70.55 253.22

Harvard Pilgrim Hlth Care-NE - Southeastern Massachusetts 888/333-4742 701 702 37.10 89.03 47.01 112.82

Health New England - Western Massachusetts 413/787-4004 DJ1 DJ2 61.97 144.52 64.37 139.80

Kaiser Permanente - Western Massachusetts 800/597-3872 K11 K12 43.29 142.01 45.32 123.85

Michigan

Aetna U.S. Healthcare - Greater Detroit Metro area 800/537-9384 8Z1 8Z2 0.00 0.00 44.79 119.95

Blue Care Network - East MI - East Michigan Region 800/890-0871 K51 K52 43.81 129.96 47.42 127.86

Blue Care Network - East MI - East Michigan Region 800/890-0871 KN1 KN2 39.26 162.87 44.01 179.23

Blue Care Network Mid MI Reg - Mid Michigan 888/227-2345 LN1 LN2 58.83 175.39 49.65 130.78

Blue Care Network SE Michigan - Southeast MI 800/662-6667 LX1 LX2 31.46 110.89 33.37 110.40

Blue Care Network West MI - Western Michigan 800/775-2583 G71 G72 47.14 169.67 89.35 273.48

Blue Care Network West MI - Western Michigan 800/775-2583 KF1 KF2 37.27 103.87 43.32 130.24

Blue Care Network West Region - Western Michigan 800/775-2583 KR1 KR2 37.21 123.98 42.51 144.50

Grand Valley Health Plan - Grand Rapids area 616/949-2410 RL1 RL2 45.03 149.39 46.82 126.02

Health Alliance - Southeastern Michigan/Flint area 313/872-8100 521 522 42.90 146.53 43.51 115.28

HealthPlus MI - Flint/Saginaw areas 800/332-9161 X51 X52 61.28 192.32 70.53 208.13

M-Care - Mid/Southeastern Michigan 800/658-8878 EG1 EG2 45.20 143.78 41.37 109.73

Medical Value Plan - Lenawee/Monroe Counties 419/245-5135 EV1 EV2 41.92 134.40 55.06 210.02

OmniCare - Southeastern Michigan 313/259-4000 KA1 KA2 42.87 120.47 39.93 99.82

Physicians Health Plan - Lansing/Mid-Michigan 517/349-1976 U51 U52 47.74 149.33 50.03 132.82
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

39

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plansAccreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data

Maine

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

NYLCare Health Plans of Maine 

Maryland

Aetna U.S. Healthcare 11 36 31 * * * * * * * * * * 2

CapitalCare 20 36 29 * h * * * * * * * *

George Washington Univ HP-High 18 40 25 h * * * * f * * * * h

George Washington Univ HP-Std 13 31 33 * * f * * f * * * * h

Kaiser Permanente* 23 39 24 h * f * * f f * f * 2

MD-IPA 15 45 30 * * * * * h h * h h ✔ 2

NYLCare/Mid-Atlantic-High 17 42 23 * * * * * * * * * * 2

NYLCare/Mid-Atlantic-Std 11 41 31 * * * * * * * * * * 2

Massachusetts

Aetna U.S. Healthcare 12 36 27 * * * * * * * * * * 2

Fallon Community Health Plan 29 49 13 h h h h h h h h h h ✔ 2

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

Harvard Pilgrim Hlth Care-NE 25 40 20 * * * * * * * * * * 2

Health New England 13 53 24 h * * h * h h * * h ✔ *

Kaiser Permanente 15 40 30 h h * * * * * * * * 2

Michigan

Aetna U.S. Healthcare 

Blue Care Network - East MI 13 39 26 * * * f * * * f * f 2

Blue Care Network - East MI 2

Blue Care Network Mid MI Reg 15 41 22 * * * * h * * * * * 2

Blue Care Network SE Michigan 15 38 29 f * * * * * f * f * 2

Blue Care Network West MI 2

Blue Care Network West MI 20 43 26 * * h * * * * * * * ✔ 2

Blue Care Network West Region 15 49 27 * * * * * * * * h * ✔ 2

Grand Valley Health Plan 

Health Alliance 18 48 22 * * * * * * * * * * ✔ 2

HealthPlus MI 2

M-Care 32 40 17 * * h h * * h h h * ✔ h

Medical Value Plan 2

OmniCare 15 32 29 f f f f f * f f f f h

Physicians Health Plan 20 45 26 * h h h * h h h h h ✔
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

40

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Michigan (continued)

Physicians Health Plan - Jackson/South Michigan 517/787-6865 U61 U62 93.04 258.01 51.45 146.47

Physicians Health Plan - Kalamazoo/Southwest Michigan 616/341-7250 U71 U72 76.27 217.80 44.61 107.06

Physicians Health Plan - Muskegon/Western Michigan 616/728-6333 U81 U82 51.42 158.10 47.23 113.38

Priority Health - West Michigan 616/942-1221 BQ1 BQ2 39.95 143.20 44.37 153.99

SelectCare - Southeast Michigan 800/332-2365 K61 K62 34.52 91.51 39.90 111.73

The Wellness Plan - Southeastern Michigan 800/875-9355 K31 K32 37.42 102.17 40.36 110.18

Total Health Care - Greater Detroit/Flint areas 800/826-2862 N21 N22 38.91 95.51 42.25 106.39

Minnesota

Altru Health Plan - Northwest Minnesota 701/780-1600 2R1 2R2 34.75 100.04 35.56 102.37

HealthPartners Classic-High - Minneapolis/St. Paul areas 612/883-5000 531 532 41.07 127.90 56.83 163.56

HealthPartners Classic-Std - Minneapolis/St. Paul areas 612/883-5000 534 535 32.99 87.58 45.05 108.11

HealthPartners Health Plan - Minneapolis/St. Paul/St. Cloud areas 612/883-5000 HQ1 HQ2 45.87 150.48 68.14 190.78

Mississippi

PrimeHealth of Alabama, Inc. - Southern Mississippi 800/236-9421 AA1 AA2 87.91 141.27 49.01 136.35

Prudential HealthCare HMO - Desoto/Marshall/Tate/Tunica Cos. 901/541-9400 UB1 UB2 32.42 98.86 37.08 113.02

Missouri

BlueCHOICE - StLouis/Central/SW/Poplar Bluff area 800/634-4395 9G1 9G2 54.47 119.15 66.89 135.29

Group Health Plan - St. Louis area 800/743-3901 MM1 MM2 72.96 231.38 57.11 185.51

Health Partners of the Midwest - St. Louis/Columbia/Jefferson City areas 800/338-4123 RN1 RN2 45.21 98.22 71.91 147.29

Humana Kansas City, Inc.-High - Central Missouri/Springfield area 888/393-6765 7S1 7S2 37.03 99.53 51.09 143.02

Humana Kansas City, Inc.-Std - Central Missouri/Springfield area 888/393-6765 7S4 7S5 34.24 92.04 47.01 112.84

Humana Kansas City, Inc.-High - Kansas City area 888/393-6765 MS1 MS2 45.60 129.57 49.99 132.47

Humana Kansas City, Inc.-Std - Kansas City area 888/393-6765 MS4 MS5 42.35 101.63 46.57 111.76

Kaiser Permanente - Kansas City area 913/642-2662 HA1 HA2 33.87 87.39 37.97 97.95

Mercy Health Plans/Premier - East/Central/Southwest Missouri 800/327-0763 7M1 7M2 47.80 135.31 47.76 111.09

Principal St.Louis - St. Louis area 800/966-3938 121 122 46.73 101.87 80.36 168.01

Prudential HealthCare HMO - Kansas City area 800/441-5588 1K1 1K2 42.33 128.23 48.82 120.30

Prudential HealthCare HMO - St. Louis area 800/298-7625 VZ1 VZ2 37.22 94.04 37.95 95.85

United HealthCare MidWest - Kansas City area 800/357-0975 4M1 4M2 51.55 180.94 62.62 202.85

United HealthCare Select - St. Louis/Central/Northeast/Southeast 800/627-0607 H81 H82 48.45 132.04 51.32 124.82

Montana

Yellowstone Community Health - Billings area 406/238-6868 2Y1 2Y2 36.89 95.68 43.04 111.59

Nebraska

Care Choices - Northeastern Nebraska 800/535-6252 FA1 FA2 41.19 134.99 48.48 174.14
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

41

Michigan (continued)

Physicians Health Plan 

Physicians Health Plan 

Physicians Health Plan 

Priority Health 22 54 16 * h h h * h * h * * ✔ 2

SelectCare 7 39 29 * f f f * f f f f f h

The Wellness Plan 

Total Health Care 

Minnesota

Altru Health Plan 

HealthPartners Classic-High 11 44 23 * * * * * f * * * * 2

HealthPartners Classic-Std* 25 45 16 h * * * * * * * * * 2

HealthPartners Health Plan 14 39 27 * * * * * f * * * * 2

Mississippi

PrimeHealth of Alabama, Inc. 11 36 28 f * * * f * * h * *

Prudential HealthCare HMO 10 37 34 f f f f f f f * * f h

Missouri

BlueCHOICE 13 31 38 * * * * * * * * * *

Group Health Plan* 15 48 25 * * * * * * * * * * *

Health Partners of the Midwest 18 43 23 h * * h * * * * * *

Humana Kansas City, Inc.-High 16 39 29 * * h * * h h * * h 2

Humana Kansas City, Inc.-Std 2

Humana Kansas City, Inc.-High 22 37 24 * * * * * * * * * * 2

Humana Kansas City, Inc.-Std 2

Kaiser Permanente 18 35 25 * * f f * f f f f f 2

Mercy Health Plans/Premier 

Principal St.Louis 20 45 25 h * h h * * * * * * ✔ h

Prudential HealthCare HMO 11 42 24 * * * * * * * * h * 2

Prudential HealthCare HMO 2

United HealthCare MidWest* 13 46 24 h * * h * h * h * *

United HealthCare Select 17 41 27 * * * * h h * * * *

Montana

Yellowstone Community Health 

Nebraska

Care Choices 

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

42

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Nebraska (continued)

Exclusive Healthcare - Omaha/Lincoln areas 800/456-9292 9Y1 9Y2 38.59 108.68 48.08 175.00

United HealthCare/Midlands - Lincoln/Omaha/Northeast areas 402/445-5700 NF1 NF2 43.82 117.96 48.04 108.71

Nevada

Aetna U.S. Healthcare - Southern Nevada/Las Vegas area 800/537-9384 8L1 8L2 0.00 0.00 40.87 107.04

Hometown Health Plan - Northern Nevada 702/325-3000 4H1 4H2 40.09 95.59 44.83 106.91

Humana Health Plan, Inc. - Las Vegas areas 888/393-6765 TL1 TL2 34.30 98.71 34.09 98.11

PacifiCare of Nevada - LasVegas/Carson City/Reno 800/811-7305 K91 K92 33.97 86.02 39.29 99.48

New Hampshire

Aetna U.S. Healthcare - Chshre/Hllsbrgh/Rcknghm/Stafford Cos. 800/537-9384 UJ1 UJ2 46.74 191.49 50.86 195.98

Harvard Community Hlth Plan - Southern New Hampshire 888/333-4742 681 682 78.70 279.00 70.55 253.22

Kaiser Permanente - Southwestern New Hampshire 800/597-3872 K11 K12 43.29 142.01 45.32 123.85

New Jersey

Aetna U.S. Healthcare-High - All of New Jersey 800/537-9384 P31 P32 124.15 355.60 130.24 364.13

Aetna U.S. Healthcare-Std - All of New Jersey 800/537-9384 P34 P35 43.96 152.06 47.23 146.92

AmeriHealth HMO, Inc. - All of New Jersey 800/454-7651 FK1 FK2 71.83 240.87 75.51 246.96

CIGNA CoMED HealthCare - All of New Jersey 800/462-6633 P41 P42 79.22 158.34 107.90 206.94

First Option Hlth Plan of NJ - All of New Jersey 800/555-2605 2F1 2F2 86.06 277.62 93.84 257.36

HIP Health Plan of NJ - Most of New Jersey 732/937-7600 P91 P92 46.44 154.38 53.45 174.40

Prudential HealthCare HMO - All of New Jersey 800/422-7399 8P1 8P2 68.51 241.48 50.03 157.28

QualMed Plans for Health - Burlington/Camden/Gloucester Counties 800/998-2840 271 272 44.59 103.98 73.52 186.44

New Mexico

HMO New Mexico - Most of New Mexico 800/423-1630 5H1 5H2 36.73 94.77 37.88 97.73

Lovelace Health Plan - All of New Mexico 505/262-7363 Q11 Q12 33.35 86.73 45.14 121.94

Presbyterian Health Plan - All NM counties except Otero & S. Eddy 505/923-5678 P21 P22 26.78 69.90 36.86 96.13

QualMed Plans for Health - Albuquerque/Santa Fe areas 800/365-0009 PX1 PX2 35.33 93.28 37.58 99.13

New York

Aetna U.S. Healthcare - NYC area and Dutchess/Sullivan/Ulster 800/537-9384 JC1 JC2 46.65 164.15 50.02 159.12

Blue Choice - Rochester area 716/238-4300 MK1 MK2 36.21 91.56 42.58 106.38

BlueChoice HMO - MidHudson area 800/453-0113 5K1 5K2 46.32 178.38 39.07 102.15

BlueChoice HMO - Albany area 800/453-0113 5L1 5L2 38.77 101.91 44.42 116.81

BlueChoice HMO - Downstate area 800/453-0113 S71 S72 50.21 198.90 50.27 177.93

C.D.P.H.P. - Capital District area 518/862-3750 SG1 SG2 38.61 102.98 40.78 104.42

CIGNA HealthCare of NY - New York City area 800/345-9458 HU1 HU2 43.05 151.52 49.47 180.88

Harvard Community Hlth Plan - New York adjacent to Massachusetts 888/333-4742 681 682 78.70 279.00 70.55 253.22
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

43

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Nebraska (continued)

Exclusive Healthcare 15 40 29 * h * * * * * * h *

United HealthCare/Midlands 20 33 28 * * * * h * * * * * 2

Nevada

Aetna U.S. Healthcare 

Hometown Health Plan 16 39 21 * f * f f * f f * *

Humana Health Plan, Inc. 

PacifiCare of Nevada 8 24 31 f f f f f f f f f f 2

New Hampshire

Aetna U.S. Healthcare 

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

Kaiser Permanente 15 40 30 h h * * * * * * * * 2

New Jersey

Aetna U.S. Healthcare-High 14 38 28 * * * * * * * * * * 2

Aetna U.S. Healthcare-Std 9 42 34 h h h h * * * * * * 2

AmeriHealth HMO, Inc. 10 37 30 * * * * * * * * * * h

CIGNA CoMED HealthCare 10 34 34 * * * * * * * * * * 2

First Option Hlth Plan of NJ 14 30 32 * * * * h * * * * *

HIP Health Plan of NJ 13 30 35 * f * f * f f f * * h

Prudential HealthCare HMO 2

QualMed Plans for Health* 12 33 32 * f f f f * f * f f h

New Mexico

HMO New Mexico 

Lovelace Health Plan* 24 38 29 * * * * * f * * * * ✔ 22

Presbyterian Health Plan 8 29 32 f f f f f f f f f f

QualMed Plans for Health 20 46 22 * * * * f * * * * * ✔

New York

Aetna U.S. Healthcare 17 35 32 * * * * * * * * * * 2

Blue Choice 22 45 21 * * * h * * h h * h ✔ 2

BlueChoice HMO h

BlueChoice HMO h

BlueChoice HMO* 17 33 25 * * * * * * * * * * h

C.D.P.H.P. 25 47 21 h h h h h h h h h h ✔ 2

CIGNA HealthCare of NY 

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

44

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

New York (continued)

HealthCarePlan - Western New York 716/847-0881 Q81 Q82 35.98 102.98 35.27 100.01

Healthsource HMO of NY - Syracuse/Central NY area 315/449-1100 XL1 XL2 48.23 205.14 49.53 184.49

HIP of Greater New York - New York City area 800/HIP-TALK 511 512 40.69 99.34 45.54 111.45

HMO Blue - Utica/Rome/Central New York areas 315/731-2547 AH1 AH2 36.59 92.96 46.18 122.53

HMO-CNY - Syracuse/Binghamton/Elmira areas 800/447-6269 EB1 EB2 38.94 99.02 47.63 157.13

Independent Health Assoc - Metro Hudson 800/486-5840 C11 C12 71.46 260.96 59.87 226.94

Independent Health Assoc - Western New York 800/453-1910 QA1 QA2 30.74 86.31 30.85 86.72

Kaiser Permanente - Albany/Cooperstown areas 800/597-3872 PW1 PW2 39.25 99.39 44.94 114.44

Kaiser Permanente - Hudson Valley area 800/597-3872 QB1 QB2 46.17 164.45 47.52 146.75

Kaiser Permanente - Westchester County 800/597-3872 QH1 QH2 43.54 116.57 45.61 111.33

MDNY Healthcare, Inc. - Nassau/Suffolk Counties 516-454-1900 5Y1 5Y2 0.00 0.00 62.62 203.02

MVP Health Plan - Eastern Region 888/687-6277 GA1 GA2 40.48 103.37 43.62 111.11

MVP Health Plan - Central Region 888/687-6277 M91 M92 38.99 99.11 39.49 100.61

MVP Health Plan - Mid-Hudson Region 888/687-6277 MX1 MX2 45.99 159.25 47.41 135.38

Partners Health Plans - Northern/Capital/Mid-Hudson areas 800-447-8610 7Y1 7Y2 0.00 0.00 47.92 149.46

PHP/Mohawk Valley Region - Utica area 315/797-7019 SH1 SH2 44.21 160.29 47.41 155.74

Preferred Care - Rochester area 716/325-3113 GV1 GV2 38.70 98.19 40.91 103.79

Prepaid Health Plan - Syracuse/Southern Tier areas 315/638-2133 QE1 QE2 45.10 168.18 50.08 183.71

Prudential HealthCare HMO - NYC/Long Island/Hudson Valley Cos. 800/422-7399 9P1 9P2 59.35 177.02 44.24 106.08

Vytra Health Plans - Queens/Nassau/Suffolk Counties 516/694-4000 J61 J62 50.44 197.45 58.67 214.11

WellCare of New York - Bronx/Brklyn/Manhattan/Queens/Westchster 800/438-9269 6V1 6V2 47.23 166.73 56.81 109.88

WellCare of New York - Capital/Hudson Valley Regions 800/438-9269 X41 X42 42.09 115.49 42.56 106.89

North Carolina

Aetna U.S. Healthcare - Charlotte/Metrolina area 800/537-9384 3G1 3G2 40.47 115.01 46.45 138.08

Doctors Health Plan, Inc. - Greater Tri/Char/Up-Low Cape Fear areas 800/476-2303 6D1 6D2 44.35 170.76 44.72 135.68

Generations Family Health Plan - Tri. area:Raleigh/Durham/Chapel Hill 888/256-5563 8B1 8B2 0.00 0.00 45.65 114.13

Kaiser Permanente - Charlotte/Triangle areas 800/755-1925 QT1 QT2 32.23 96.70 39.04 121.01

PARTNERS NHP of NC - Most of North Carolina 800/942-5695 EQ1 EQ2 45.40 102.15 51.12 115.02

Personal Care Plan of NC - Charlotte/Durham/Greensboro/Raleigh 800/755-0817 4X1 4X2 45.81 121.03 67.45 176.22

Prudential HealthCare HMO - Charlotte/Raleigh areas 800/643-3609 Q41 Q42 33.40 93.51 37.59 105.20

UHC of North Carolina - Central/Eastern/Western 800/999-1147 XM1 XM2 66.04 163.41 55.25 129.59

WellPath Select - Charlotte/Triangle/surr. area 800/935-7284 2E1 2E2 38.03 98.88 46.06 131.15

North Dakota

Altru Health Plan - Northeast North Dakota 701/780-1600 2R1 2R2 34.75 100.04 35.56 102.37
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

45

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data

New York (continued)

HealthCarePlan 23 47 17 * h * * h f * * * * ✔ 2

Healthsource HMO of NY 2

HIP of Greater New York 10 32 37 * f f f f f f f f f 2

HMO Blue 

HMO-CNY* 23 46 27 * h h h h h h h h h ✔ h

Independent Health Assoc 14 43 27 * h * * h h * h h * !

Independent Health Assoc 11 47 32 * h * h h h h * * * ✔ 2

Kaiser Permanente 16 44 23 * * * * * * * * * * 2

Kaiser Permanente 22 40 21 * * * * h * * * * * 2

Kaiser Permanente 

MDNY Healthcare, Inc. 

MVP Health Plan 17 46 23 * * * h * * * h * * 2

MVP Health Plan 11 44 29 f * * h h h h h h h 2

MVP Health Plan 22 43 21 * h h h h h h h h * 2

Partners Health Plans 

PHP/Mohawk Valley Region* 24 43 20 * h * * h h h * h h

Preferred Care 20 50 20 * * * * * * * * * * ✔ 2

Prepaid Health Plan 15 45 25 * * * * h * * * * *

Prudential HealthCare HMO 2

Vytra Health Plans 23 43 19 h h * h h h h h h h

WellCare of New York h

WellCare of New York h

North Carolina

Aetna U.S. Healthcare 13 29 31 * * * * h * * h * h

Doctors Health Plan, Inc. 9 36 31 f * * * * * * * * *

Generations Family Health Plan

Kaiser Permanente 21 37 26 h * * * * * * * * * 2

PARTNERS NHP of NC 15 43 26 * * * h * h * * * * h

Personal Care Plan of NC 18 42 23 * * * h h h * * h * 2

Prudential HealthCare HMO 13 36 28 * * * * * f * * * * h

UHC of North Carolina 19 40 26 * h * h * * h * * *

WellPath Select 

North Dakota

Altru Health Plan 
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

46

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

North Dakota (continued)

HealthPartners Health Plan - Eastern North Dakota 612/883-5000 HQ1 HQ2 45.87 150.48 68.14 190.78

Heart of America HMO - Northcentral North Dakota 701/776-5848 RU1 RU2 43.59 136.31 45.27 114.49

Ohio

Aetna U.S. Healthcare - Most of Ohio 800/537-9384 RD1 RD2 47.80 153.60 52.00 161.64

AultCare HMO - Stark/Carroll/Holmes/Tuscarawas/Wayne Co 330/438-6360 3A1 3A2 42.89 139.51 48.15 125.28

CHP of Ohio - Northeastern/Central/Southern Ohio 740/348-1449 MG1 MG2 39.47 74.64 42.92 172.43

DayMed Hlth Maintenance Plan - Dyton/Cincinnati/Columbs/Cleve/Akrn 937/847-5646 Q31 Q32 46.20 141.70 49.60 135.53

Health Maintenance Plan(HMP) - Most of Ohio 800/228-4375 R51 R52 44.78 103.72 51.50 118.02

Health Plan Upper OH Valley - Eastern Ohio 800/624-6961 U41 U42 65.46 212.66 41.32 103.29

Health Power HMO - Columbus/Cincinnati/Dayton areas 800/338-6207 XR1 XR2 45.73 149.09 48.01 132.69

HealthAssurance HMO - Eastern Ohio 800/735-2202 5X1 5X2 46.99 129.01 45.88 106.75

HMO Health Ohio - Northeast Ohio 800/258-3466 L41 L42 47.44 177.11 47.45 138.00

Kaiser Permanente - Akron/Cleveland areas 216/621-7100 641 642 43.90 100.97 48.18 110.82

Medical Value Plan - Toledo area 419/245-5135 EV1 EV2 41.92 134.40 55.06 210.02

PacifiCare of Ohio, Inc. - Cincinnati/Dayton areas 800/824-0428 R81 R82 45.53 121.75 48.13 113.10

Paramount Health Care - Northwest/North Central Ohio 800/462-3589 U21 U22 43.75 155.48 48.12 162.46

Prudential HealthCare Midwest - Central Ohio 800/452-3094 AY1 AY2 49.88 115.03 47.61 104.54

Prudential HealthCare Midwest - Cleveland/Akron/Youngstown areas 800/458-3941 Q91 Q92 41.91 98.26 39.64 92.94

Prudential HealthCare Midwest - Cincinnati/Southwest areas 800/932-7478 S31 S32 39.05 101.43 41.70 108.29

QualMed Plans for Health OH/WV - Eastern Ohio 800/333-3930 QJ1 QJ2 40.16 98.39 46.38 132.69

SummaCare Health Plan - Northern Ohio 330/996-8700 5W1 5W2 38.68 96.71 39.82 109.49

Super Med HMO - Northeast Ohio 800/574-2583 5M1 5M2 52.16 190.80 43.66 111.68

United Health Care of Ohio - Cincinnati/Dayton/Springfield/Toledo 800/231-2918 3U1 3U2 53.33 132.47 64.52 159.92

United Health Care of Ohio - Central/South Central Ohio 800/225-7951 VC1 VC2 73.17 188.72 58.83 146.90

Oklahoma

Aetna U.S. Healthcare - Northeast Oklahoma 800/537-9384 8V1 8V2 0.00 0.00 41.23 107.65

BlueLincs HMO - OK City/Tulsa/Lawton/SW Oklahoma areas 800/722-5675 N51 N52 41.18 99.81 46.33 108.47

CommunityCare HMO - Oklahoma City/Tulsa areas 800/777-4890 7C1 7C2 34.24 88.26 41.51 107.01

Healthcare Oklahoma - Oklahoma City/Lawton/Tulsa/Enid areas 800/535-2244 6W1 6W2 38.69 100.78 42.51 110.44

PacifiCare OK - Okla Cty/Southwestern OK and Tulsa area 800/735-5052 2N1 2N2 36.85 100.68 39.64 109.32

Prudential HealthCare HMO - Central/Western/Southern Oklahoma 800/416-3206 RR1 RR2 36.31 96.63 38.60 102.75

Prudential HealthCare HMO - Tulsa area 800/345-8310 RS1 RS2 38.05 94.47 45.07 99.74

Oregon

Kaiser Permanente-High - Portland/Salem areas 503/813-2000 571 572 58.16 151.84 61.40 151.76
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

47

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

North Dakota (continued)

HealthPartners Health Plan 14 39 27 * * * * * f * * * * 2

Heart of America HMO 

Ohio

Aetna U.S. Healthcare 11 29 30 * * * * * * * h * * 2

AultCare HMO 19 39 24 h * * * h h * h * *

CHP of Ohio 24 45 21 h * * * * h * * * * ✔

DayMed Hlth Maintenance Plan* 15 34 27 * * * h * * * h * h

Health Maintenance Plan(HMP) 11 41 26 * * * * * * h * * h 2

Health Plan Upper OH Valley 15 37 25 f * * * h * * * * * 2

Health Power HMO 2

HealthAssurance HMO 

HMO Health Ohio 

Kaiser Permanente 16 43 21 * * * * f f * f * * 2

Medical Value Plan 2

PacifiCare of Ohio, Inc. 9 37 28 f * * * * * * * * *

Paramount Health Care 2

Prudential HealthCare Midwest 11 38 30 * * h h * h h * * * h

Prudential HealthCare Midwest 10 32 29 * * * * * * * * * * 2

Prudential HealthCare Midwest 12 46 27 * * * h * * * * * * 2

QualMed Plans for Health OH/WV

SummaCare Health Plan 

Super Med HMO 

United Health Care of Ohio 12 40 30 * h * h * h h h * * 2

United Health Care of Ohio 17 37 27 * h * * * h * * * * 2

Oklahoma

Aetna U.S. Healthcare 

BlueLincs HMO 12 37 35 * * f f * * f * f * 2

CommunityCare HMO 2

Healthcare Oklahoma 15 43 23 * * * * f * * * * *

PacifiCare OK* 17 27 31 * f f f f f f f f f 2

Prudential HealthCare HMO 24 37 21 * * * * h h * * * * 2

Prudential HealthCare HMO 23 40 21 * * * * * * * * * * 2

Oregon

Kaiser Permanente-High 20 44 22 h h h * * f * * * * 2

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

48

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Oregon (continued)

Kaiser Permanente-Std - Portland/Salem areas 503/813-2000 574 575 43.71 100.52 45.45 104.31

PacifiCare of Oregon - Counties along I-5 Corridor 800/932-3004 SS1 SS2 44.27 98.34 48.36 107.13

Providence Health Plan - Western Oregon/I-5(Rosebrg-Salem) Coast 800/421-0544 SD1 SD2 43.32 111.82 49.35 131.11

Regence Hlth Maintenance of OR - Portland area 800/278-5331 6B1 6B2 45.03 99.70 57.11 124.61

Regence HMO Oregon - Portland area/I-5 Corridor/Western OR 800/278-5331 7A1 7A2 45.03 99.70 57.11 124.61

Pennsylvania

Aetna U.S. Healthcare-High - Southwestern and Central PA 800/537-9384 KL1 KL2 45.62 177.93 46.58 149.18

Aetna U.S. Healthcare-Std - Southwestern and Central PA 800/537-9384 KL4 KL5 39.44 112.95 42.72 114.04

Aetna U.S. Healthcare-High - Southeastern PA 800/537-9384 SU1 SU2 64.03 241.74 67.95 247.46

Aetna U.S. Healthcare-Std - Southeastern PA 800/537-9384 SU4 SU5 42.99 144.17 46.61 142.85

First Priority Hlth - Northeastern Pennsylvania 800/822-8753 C81 C82 40.60 110.39 46.12 128.03

HealthAmerica Pennsylvania - Pittsburgh/Northeast/Central/S. Central 800/788-8445 261 262 41.72 184.67 45.02 120.73

HealthGuard - Berks/Cmbrlnd/Dauphine/Lanc/Lebanon/York 800/822-0350 NQ1 NQ2 40.22 119.73 44.92 123.31

HIP Health Plan of Penn. - Bucks/Chester/Delaware/Montgomery/Phila 215/633-2265 5J1 5J2 46.32 184.78 46.54 147.66

Keystone Health Plan Central - Harrisburg/Norther Region/Lehigh Valley 800/622-2843 S41 S42 44.60 126.88 54.54 164.19

Keystone Health Plan East - Philadelphia area 800/227-3115 ED1 ED2 44.91 167.55 48.95 168.94

KeystoneBlue - Pittsburgh/Altoona/Erie areas 800/KHP-WEST EF1 EF2 46.53 245.88 37.68 111.79

Prudential HealthCare HMO - Philadelphia/Lehigh Valley areas 800/648-4478 VV1 VV2 38.16 111.59 41.10 113.03

QualMed Plans for Health -Pa. - Pittsburgh area 800/333-3930 241 242 42.05 129.05 47.69 148.48

QualMed Plans for Health - Southern Pennsylvania 800/998-2840 271 272 44.59 103.98 73.52 186.44

QualMed Plans for Health - Scranton/Wilkes Barre 800/998-2840 2K1 2K2 41.83 96.68 45.93 111.53

Rhode Island

Aetna U.S. Healthcare - All of Rhode Island 800/537-9384 5U1 5U2 39.05 115.18 40.56 109.96

Harvard Pilgrim Hlth Care-NE - All of Rhode Island 888/333-4742 701 702 37.10 89.03 47.01 112.82

South Carolina

Aetna U.S. Healthcare - Portions of South Carolina 800/537-9384 3G1 3G2 40.47 115.01 46.45 138.08

Doctors Health Plan, Inc. - York County 800/476-2303 6D1 6D2 44.35 170.76 44.72 135.68

Kaiser Permanente - Rock Hill area 800/755-1925 QT1 QT2 32.23 96.70 39.04 121.01

PARTNERS NHP of NC - Upstate South Carolina 800/942-5695 EQ1 EQ2 45.40 102.15 51.12 115.02

Prudential HealthCare HMO - York County 800/643-3609 Q41 Q42 33.40 93.51 37.59 105.20

WellPath Select - Chest/Grnvill/Lancst/Pickns/Sprtnbrg/Yrk 800/935-7284 2E1 2E2 38.03 98.88 46.06 131.15

South Dakota

Care Choices - Clay/Union Counties 800/535-6252 FA1 FA2 41.19 134.99 48.48 174.14
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

49

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

1997 Survey data

Oregon (continued)

Kaiser Permanente-Std 16 41 28 * * * * * f * * * * 2

PacifiCare of Oregon* 12 48 24 f * h * * * * * * * h

Providence Health Plan 16 35 27 f * * f f * f * f f

Regence Hlth Maintenance of OR

Regence HMO Oregon 12 42 25 f h * h h h h h h h

Pennsylvania

Aetna U.S. Healthcare-High 13 38 32 h * * * * * * * * * 2

Aetna U.S. Healthcare-Std 10 33 30 * * * * * * * * * * 2

Aetna U.S. Healthcare-High 23 30 32 * * * * * * * * * * 2

Aetna U.S. Healthcare-Std 13 42 32 * h h h * * * * * * ✔ 2

First Priority Hlth 13 43 29 * * * h * h * * h * h

HealthAmerica Pennsylvania 10 32 31 f f f * * f * * * * 2

HealthGuard 17 47 27 * h * h * * * * * * ✔ 2

HIP Health Plan of Penn. 

Keystone Health Plan Central 19 37 30 * h h h h * h h h * 2

Keystone Health Plan East 12 44 30 h * h * * * * * * * 2

KeystoneBlue 13 41 28 * * * h * * * * h * h

Prudential HealthCare HMO 11 34 25 f * * * * * * * * * 2

QualMed Plans for Health -Pa. 

QualMed Plans for Health* 12 33 32 * f f f f * f * f f h

QualMed Plans for Health h

Rhode Island

Aetna U.S. Healthcare 

Harvard Pilgrim Hlth Care-NE 25 40 20 * * * * * * * * * * 2

South Carolina

Aetna U.S. Healthcare 13 29 31 * * * * h * * h * h

Doctors Health Plan, Inc. 9 36 31 f * * * * * * * * *

Kaiser Permanente 21 37 26 h * * * * * * * * * 2

PARTNERS NHP of NC 15 43 26 * * * h * h * * * * h

Prudential HealthCare HMO 13 36 28 * * * * * f * * * * h

WellPath Select 

South Dakota

Care Choices 
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

50

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Tennessee

Aetna U.S. Healthcare - Nashville/Middle Tennessee areas 800/537-9384 6J1 6J2 32.63 90.51 35.08 97.62

American Healthcare Trust, Inc - Knoxville/Memphis/Nashville areas 888/523-9527 4U1 4U2 34.75 98.74 34.87 96.71

Heritage National Healthplan - Chattanooga/Kingsprt/Knoxville/Grnville 800/247-9110 4T1 4T2 46.76 103.40 48.67 178.08

Prudential HealthCare HMO - Nashville area 800/770-4778 UA1 UA2 33.05 93.19 39.35 110.92

Prudential HealthCare HMO - Memphis area 901/541-9400 UB1 UB2 32.42 98.86 37.08 113.02

Texas

Aetna U.S. Healthcare - Houston area 800/537-9384 5B1 5B2 58.20 237.19 53.41 238.34

Aetna U.S. Healthcare - San Antonio area 800/537-9384 8X1 8X2 0.00 0.00 50.48 217.32

Aetna U.S. Healthcare - Dallas/Ft. Worth areas 800/537-9384 TS1 TS2 38.73 241.63 40.99 234.48

Certus HealthCare - Cameron/Hidalgo/Nueces area 888/423-7887 3Y1 3Y2 35.97 83.91 45.16 105.58

FIRSTCARE - Waco area 800/884-4901 6U1 6U2 38.69 83.08 42.87 92.10

FIRSTCARE - West Texas 800/884-4901 CK1 CK2 90.92 193.92 103.31 209.78

HealthFirst HMO - East Texas 800/365-2892 8E1 8E2 0.00 0.00 49.11 105.93

HMO Blue/Rio Grande - Austin/Beaumont/Houston/San Antonio/S.TX 800/336-5696 4Y1 4Y2 36.57 96.99 43.92 118.45

HMO Blue/Rio Grande - Dallas/Fort Worth/Tyler areas 800/554-6321 4Z1 4Z2 34.93 93.32 42.06 112.35

HMO Blue - West Texas 806/798-6362 5Q1 5Q2 35.81 95.52 45.63 139.38

HMO Blue - Southwest Texas 800/468-2602 5R1 5R2 37.91 101.13 42.84 114.27

HMO Texas, L.C. - Dallas/Ft. Worth areas 972/458-5000 UK1 UK2 47.58 161.90 43.88 108.39

Humana Health Plan of Texas - Austin/Dallas/Hston/S.Ant/C.Christi 888/393-6765 TW1 TW2 36.53 100.12 44.31 113.89

Humana Health Plan of Texas - Houston area 888/393-6765 UE1 UE2 36.74 103.87 38.25 107.23

Humana Health Plan of Texas - San Antonio area 888/393-6765 UR1 UR2 38.97 100.17 41.40 106.42

Humana of Corpus Christi - Corpus Christi area 888/393-6765 TX1 TX2 44.05 114.64 50.82 140.45

NYLCare Health Plans SW - Dallas/Ft. Worth/East & West Texas 972/791-3910 V21 V22 43.40 107.17 50.22 110.27

NYLCare HP of the Gulf Coast - Houston area 800/833-5318 UM1 UM2 46.25 172.82 49.20 164.30

NYLCare HP of the Gulf Coast - Austin/C.Christi/S.Antonio/Victoria 800/833-5318 ZE1 ZE2 35.14 91.45 36.56 95.14

NYLCare HP of the Gulf Coast - Beaumont/Lufkin areas 800/833-5318 ZF1 ZF2 45.29 101.27 45.74 102.29

PacifiCare of Texas - S Ant/Hston/Glvston/Da/Ft Wor/Glf Coast 800/825-9355 GF1 GF2 37.14 98.61 38.87 104.62

Prudential HealthCare HMO - El Paso County 800/778-1148 6P1 6P2 40.35 88.79 44.66 98.31

Prudential HealthCare HMO - Austin area 800/261-2645 UN1 UN2 30.67 82.67 36.32 97.99

Prudential HealthCare HMO - Houston area 800/876-7778 UP1 UP2 35.74 107.40 38.25 111.15

Prudential HealthCare HMO - San Antonio area 800/657-5959 VX1 VX2 37.83 98.31 40.68 105.68

Scott and White - Austin/Bryan/ColSta./Killeen/Temple/Waco 254/298-3000 UF1 UF2 73.56 253.35 74.66 251.94

WellChoice - San Antonio area 800/559-9355 3Z1 3Z2 33.80 87.88 35.15 91.39
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

51

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Tennessee

Aetna U.S. Healthcare 

American Healthcare Trust, Inc

Heritage National Healthplan 

Prudential HealthCare HMO 18 37 25 * * * * * * * * * * 2

Prudential HealthCare HMO 10 37 34 f f f f f f f * * f h

Texas

Aetna U.S. Healthcare 

Aetna U.S. Healthcare 

Aetna U.S. Healthcare 14 32 26 * * * * * * f * * f 2

Certus HealthCare 

FIRSTCARE 

FIRSTCARE 23 46 15 * * * * h * * * * *

HealthFirst HMO 

HMO Blue/Rio Grande 18 27 33 * f * * * * * f f *

HMO Blue/Rio Grande 

HMO Blue 

HMO Blue 

HMO Texas, L.C. 19 37 27 * * f f * f f f f f 2

Humana Health Plan of Texas 14 40 23 * * * f * * * * * * 2

Humana Health Plan of Texas 12 29 31 * f * f f * * f * * 2

Humana Health Plan of Texas 14 35 32 * f f f f f f f f f 2

Humana of Corpus Christi 16 33 30 f f f f f f f f * f

NYLCare Health Plans SW 18 38 27 * f * * f * f * * f 2

NYLCare HP of the Gulf Coast* 19 37 25 * * * * f * * * * * 2

NYLCare HP of the Gulf Coast* 3 39 28 * * * * f * * * * * 2

NYLCare HP of the Gulf Coast 2

PacifiCare of Texas* 20 35 26 * f f f f f f f f f

Prudential HealthCare HMO 2

Prudential HealthCare HMO 19 38 23 * * * * * f * * f * 2

Prudential HealthCare HMO 16 35 33 h f * * f f f * * f 2

Prudential HealthCare HMO 24 39 25 * * * * * * * * * * 2

Scott and White 26 41 19 h * h h f * * * h * h

WellChoice 

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

52

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Utah

PacifiCare of Utah - Wasatch Front 800/377-4161 9K1 9K2 0.00 0.00 46.80 110.62

Vermont

Harvard Community Hlth Plan - Southern Vermont 888/333-4742 681 682 78.70 279.00 70.55 253.22

Kaiser Permanente - All of Vermont 800/597-3872 8M1 8M2 39.56 103.16 45.48 125.47

MVP Health Plan - Bennington/Chittenden/Rutland/Wash. Cos. 888/687-6277 VW1 VW2 43.31 124.98 51.94 171.75

Virginia

Aetna U.S. Healthcare - Northern Virginia area 800/537-9384 V81 V82 64.03 197.49 74.21 215.50

Aetna U.S. Healthcare - Richmond/Central/Tri-City areas 800/537-9384 Z11 Z12 44.55 138.56 50.98 164.52

CapitalCare - Northern Virginia 800/680-9495 2G1 2G2 39.80 129.57 56.83 238.16

CIGNA HealthCare of VA - Southeastern Virginia 800/533-1708 W21 W22 42.01 93.66 48.91 107.39

CIGNA HealthCare of VA - Central Virginia 800/533-1708 W31 W32 44.04 99.15 47.92 108.31

George Washington Univ HP-High - N. Virginia/Fredericksburg/Winchester 301/941-2000 E51 E52 83.49 187.48 73.75 155.33

George Washington Univ HP-Std - N. Virginia/Fredericksburg/Winchester 301/941-2000 E54 E55 36.97 80.60 42.27 92.05

Healthkeepers - Peninsula/Richmond/Frdburg/Roanoke areas 800/421-1880 X81 X82 38.98 101.90 70.09 226.98

Heritage National Healthplan - Bristol/Roanoke areas 800/247-9110 4T1 4T2 46.76 103.40 48.67 178.08

Kaiser Permanente - Washington, DC area 301/468-6000 E31 E32 42.82 114.73 47.30 119.75

MD-IPA - N.VA/Cntrl VA/Richmond/Tidewater/Roanoke 800/331-2102 JP1 JP2 42.84 103.03 50.46 136.91

NYLCare/Mid-Atlantic-High - N.VA/Fredericksburg/Richmond/Tri-Cities 800/635-3121 JN1 JN2 52.22 150.33 50.47 126.97

NYLCare/Mid-Atlantic-Std - N.VA/Fredericksburg/Richmond/Tri-Cities 800/635-3121 JN4 JN5 33.24 78.10 35.67 83.82

OPTIMA Health Plan - Peninsula/Southside Hampton Roads 757/552-7500 9R1 9R2 0.00 0.00 50.67 132.10

PARTNERS NHP of NC - Southwest Virginia 800/942-5695 EQ1 EQ2 45.40 102.15 51.12 115.02

Priority Health Care, Inc. - Southside Hampton Rds.(excl. Peninsula) 800-640-0007 W71 W72 40.29 131.09 47.84 175.65

Prudential HealthCare HMO - Richmond/Tri-City areas 800/323-0467 V61 V62 33.09 89.34 38.79 104.69

Washington

Aetna U.S. Healthcare - Western/Southeast Washington 800/537-9384 8J1 8J2 0.00 0.00 41.86 109.62

First Choice Health Plan - Greater Seattle area 800/783-7312 5G1 5G2 40.42 111.54 44.56 115.70

Group Health Cooperative - Most of Western Washington 206/448-4140 541 542 47.05 136.26 54.90 128.66

Group Health Cooperative - Central WA/Spokane/Colville/Pullman 800/497-2210 VR1 VR2 63.31 217.32 63.38 217.60

HealthPlus - Most of Washington state 800/527-6675 8F1 8F2 0.00 0.00 48.29 134.55

Kaiser Permanente-High - Vancouver/Longview 503/813-2000 571 572 58.16 151.84 61.40 151.76

Kaiser Permanente-Std - Vancouver/Longview 503/813-2000 574 575 43.71 100.52 45.45 104.31

Kitsap Physicians Service-High - Kitsap/Mason/Jefferson Counties 800/552-7114 VT1 VT2 199.47 424.04 186.25 384.78

Kitsap Physicians Service-Std - Kitsap/Mason/Jefferson Counties 800/552-7114 VT4 VT5 53.65 121.25 50.94 111.32

NYLCare Northwest - Puget Sound/Much of Westn/Centr/Eastn WA 800/654-6506 8N1 8N2 42.72 103.98 44.43 107.18
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

53

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Utah

PacifiCare of Utah 9 35 29 * * f * * f * * * * h

Vermont

Harvard Community Hlth Plan 27 43 19 * * * h h * h h * * ✔ 2

Kaiser Permanente 13 45 29 * h * * h * * h * * ✔ 2

MVP Health Plan* 14 45 25 * h * * h * h h h h h

Virginia

Aetna U.S. Healthcare 11 36 31 * * * * * * * * * * 2

Aetna U.S. Healthcare 11 32 27 * * * * * * * * * * h

CapitalCare 20 36 29 * h * * * * * * * *

CIGNA HealthCare of VA 16 42 25 * * * * * * * * * * 2

CIGNA HealthCare of VA 26 42 23 * * * * * * * * * * ✔ 2

George Washington Univ HP-High 18 40 25 h * * * * f * * * * h

George Washington Univ HP-Std 13 31 33 * * f * * f * * * * h

Healthkeepers 13 36 35 * h * * h * * * * * h

Heritage National Healthplan 

Kaiser Permanente* 23 39 24 h * f * * f f * f * 2

MD-IPA 15 45 30 * * * * * h h * h h ✔ 2

NYLCare/Mid-Atlantic-High 17 42 23 * * * * * * * * * * 2

NYLCare/Mid-Atlantic-Std 11 41 31 * * * * * * * * * * 2

OPTIMA Health Plan 21 36 27 * * * * * * * * * * h

PARTNERS NHP of NC 15 43 26 * * * h * h * * * * h

Priority Health Care, Inc. 14 38 28 * * * * * h * h h *

Prudential HealthCare HMO 15 38 31 * * * * * * * * * * 2

Washington

Aetna U.S. Healthcare 

First Choice Health Plan 

Group Health Cooperative 19 36 32 * * * * * f * * * f ✔ 2

Group Health Cooperative 15 33 31 * * h * h * * * * * 2

HealthPlus 

Kaiser Permanente-High 20 44 22 h h h * * f * * * * 2

Kaiser Permanente-Std 16 41 28 * * * * * f * * * * 2

Kitsap Physicians Service-High 24 45 19 h h h h h h h h h h ✔

Kitsap Physicians Service-Std 24 43 21 h h h h h h h h h h ✔

NYLCare Northwest 

1997 Survey data
Health Maintenance 

Organization (HMO) 

Plans by State

(Also check POS Section)

Plan name – location

54

Telephone

number

Enrollment

code

Self Self &

only family

Premium Premium

You Paid You Will Pay

in 1998 in 1999

Self Self & Self Self &

only family only family

Washington (continued)

PacifiCare of Oregon - Clark County 800/932-3004 SS1 SS2 44.27 98.34 48.36 107.13

PacifiCare of Washington - Puget Sound/Most West WA/Parts East WA 800/932-3004 WB1 WB2 34.94 90.41 42.94 111.10

Providence Health Plan - Lower Columbia Basin 800/421-0644 SD1 SD2 43.32 111.82 49.35 131.11

QualMed WA Health Plan - Most of Washington 800/869-7165 TM1 TM2 45.57 133.97 50.24 140.51

Regence Hlth Maintenance of OR - Clark County 800/278-5331 6B1 6B2 45.03 99.70 57.11 124.61

West Virginia

Carelink Health Plans - Northern/Central/Southern West Virginia 800/348-2922 4C1 4C2 64.72 158.84 43.07 160.10

Health Plan Upper OH Valley - Northern/Central West Virginia 800/624-6961 U41 U42 65.46 212.66 41.32 103.29

HealthAssurance HMO - North Central/Panhandle 800/735-2202 6L1 6L2 47.03 166.66 43.08 108.75

PrimeONE - All of West Virginia 800/607-7461 9W1 9W2 46.34 161.20 44.81 114.38

QualMed Plans for Health OH/WV - Panhandle/N. Central/Charleston area 800/333-3930 QJ1 QJ2 40.16 98.39 46.38 132.69

SuperBlue HMO - Chas/Pkg/Mgtn/Beck/Clkb/Whlg/Lew/Fmt/Blu 800/391-4441 8T1 8T2 46.27 157.41 50.69 162.46

Wisconsin

Compcare Health Services - Southeastern Wisconsin 414/226-6744 691 692 46.67 175.33 51.78 188.52

Compcare Health Services - Northcentral/Northwest Wisconsin 800/242-9635 6X1 6X2 44.52 153.08 51.10 181.70

DEAN HEALTH PLAN - South Central Wisconsin 800/279-1301 WD1 WD2 42.87 154.77 49.43 186.34

Family Health Plan - Milwaukee area 414/256-0040 WH1 WH2 54.32 203.28 74.73 250.88

Group Health Coop - Greater Dane and Jefferson Counties 608/251-3356 WJ1 WJ2 42.50 145.15 45.05 132.67

Group Hlth Coop/Eau Claire - West Central Wisconsin 715/836-8552 WT1 WT2 46.35 170.15 66.73 227.44

HealthPartners Classic-High - Pierce/St. Croix Counties 612/883-5000 531 532 41.07 127.90 56.83 163.56

HealthPartners Classic-Std - Pierce/St. Croix Counties 612/883-5000 534 535 32.99 87.58 45.05 108.11

HealthPartners Health Plan - West Central Wisconsin 612/883-5000 HQ1 HQ2 45.87 150.48 68.14 190.78

Humana Wisconsin Hlth Org. - Southeastern Wisconsin 888/393-6765 X11 X12 58.68 194.68 66.39 207.72

Physicians Plus HMO - South Central/Southeastern Wisconsin 608/282-8920 7P1 7P2 59.28 213.33 49.30 161.25

Unity Health Plans - Southern/Central Wisconsin 800/362-3310 W41 W42 45.71 158.49 51.20 175.24

Valley Health Plan - Western Wisconsin 715/832-3235 VH1 VH2 68.28 232.42 77.50 250.58
Health Maintenance 

Organization (HMO) 

Plans by State

Plan name

55

Coverage (77%)Access to care (81%)Access to care in anemergency (86%)Choice of doctor (73%)When sick, can get appointment (79%)Seeing same doctoron most visits (84%)Quality of care (76%)Provider thorough and competent (82%)Explanation of care (80%)Results of care (74%)Top rated plans

Accreditation statusN

CQA JCAH

O

Web site

Quality Indicators - Plan performance based on enrollee ratings:

h above average; * average, f below average

(Numeric average for all HMO plans in heading)

% Extremely 

satisfied

% Very

satisfied

% Somewhat 

satisfied

% satisfied with plan

Washington (continued)

PacifiCare of Oregon* 12 48 24 f * h * * * * * * * h

PacifiCare of Washington* 17 37 32 * * * * * * * * * f

Providence Health Plan 16 35 27 f * * f f * f * f f

QualMed WA Health Plan 16 35 30 * h h * h * h h * h h

Regence Hlth Maintenance of OR

West Virginia

Carelink Health Plans 

Health Plan Upper OH Valley 15 37 25 f * * * h * * * * * 2

HealthAssurance HMO 

PrimeONE 

QualMed Plans for Health OH/WV

SuperBlue HMO 

Wisconsin

Compcare Health Services* 11 37 32 * * * * * * * * * *

Compcare Health Services 

DEAN HEALTH PLAN 22 45 22 * h h h * * h h h * ✔ h

Family Health Plan 12 35 27 * * * f * f f f * f h

Group Health Coop 37 44 16 h h * * h * * * * * ✔ 2

Group Hlth Coop/Eau Claire 

HealthPartners Classic-High 11 44 23 * * * * * f * * * * 2

HealthPartners Classic-Std* 25 45 16 h * * * * * * * * * 2

HealthPartners Health Plan 14 39 27 * * * * * f * * * * 2

Humana Wisconsin Hlth Org. 14 41 26 * h * * * * * * * *

Physicians Plus HMO 

Unity Health Plans 19 36 25 * * * * * f * h h h

Valley Health Plan 

1997 Survey data
Visit our

web site at

www.opm.gov/insure

United States

Office of

Personnel Management

The Federal Government's Human Resources Agency

Retirement System Phone Number Email Address

OPM’s Retirement Information Office (Civil Service

Retirement System and Federal Employees Retirement

System)

Within the local Washington, DC calling area

1-888/767-6738

202/606-0500

retire@opm.gov

C.I.A. Office of Retirement Programs 1-800/648-5693 N/A

U.S. Lighthouse Service Retirement System 202/267-2942 Idemuth@comdt.uscg.mil

District Government Retirement System 202/727-5258 N/A

(Federal Reserve) Board Benefit Structure 202/452-3158 cimralk@frb.gov

Foreign Service Retirement and Disability System 202/647-9320 webberds@persm.us/state.gov

Judicial Survivor’s Annuity System

Judicial Retirement System 202/273-1370 carol_sefren@ao.uscourts.gov

Financial Institutions Retirement System (FIRF) 202/906-7303 valerie_waller@ots.treas.gov

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